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Requested by: Mike Hansen <br />When Recorded Mail to: <br />1Name: White Castle Roofing Phone number: 402-423-1796 <br />Address: P.O. Box 22405, Lincoln, NE 68542 <br />Claim of Construction Lien <br />State of Nebraska <br />County of HALL <br />1, Mike Hansen, being duly sworn, state the following: <br />In accordance with an agreement to provide labor and/or material, I did furnish the following labor <br />and/or materials: Roofing & gutter materials and labor on the following described real property located <br />in Hall County, State of Nebraska, commonly known as: 409 N 4th St, Doniphan,NE. , and legally <br />described as: Lot Thirteen (13) Bison Meadows, Hall County, NE which property is owned by Julie <br />Starman , whose address is 409 N 4th St, Doniphan, NE , of a total value of $ 11,797.50 , of which <br />there remains unpaid $11,797.50 , and 1 further state that I furnished the first of the items on the date <br />of August 9, 2021, and the last of the items on the date of August 31, 2021. <br />I hereby, under the laws of the State of Nebraska, claim a lien against the above-described property in <br />the ariount of money, stated above, which remains unpaid to me. <br />vvnavi O - e 130,0, -dl <br />Of White Castle Roofing & Contracting O.(- krrcAvAs <br />Name & Title of Person Claiming Lien <br />Signature of Person Claiming Lien <br />Subscribed and sworn before me this <br />Seal <br />CD <br />1--a <br />CD <br />F—► <br />Cn <br />GENERAL NOTARY -State of Nebraska <br />NICOLE CLARKE <br />My Comm. Exp. August 22, 2022 <br />day of e vylloe/v , an a 1 <br />Notary Signature <br />ON INIWfl LLSN1 SV 03'd311 <br />