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Return To: <br />Kim Osborn <br />Weathercraft Co of North Platte <br />PO Box 1949 <br />North Platte, NE 69103 <br />(308) 534-3480 <br />Construction Lien <br />1. The real estate sub)ect to this lien is: <br />to OO <br />Wodland First Sub S 126' of E 260' LT 6 XC City Hall County Grand Island Nebraska <br />2. The person against whose interest in the real estate the lien is claimed is: <br />Pam's Rental LLC <br />3. The name and address of the claimant is: <br />Duff RoofingPO Box 1062 Grand Island, NE 68802 <br />4. The name and address of the person with whom the claimant contracted is: <br />Pam's Pub & Grub <br />5. A general description of the claimant's services performed to, materials furnished for the <br />improvement and the contract price is: <br />Roof Repair <br />6. (Complete one of the following) <br />X The amount unpaid, whether due or not, to the claimant for the service 630 _ <br />The unpaid amount is not fixed by the contract, but a good faith estimate in the amount of: $ <br />7. (Complete one of the following) <br />X The time the last services or materials were furnished was: 12/7/21 <br />The time the last services or materials were furnished has not yet occurred but is estimated to occur: <br />Signature of Claimant- Scott Erickson <br />Weathercraft Co of North Platte <br />State of Nebraska <br />County of Lincoln <br />On this ifg= day of (90Qa , before me a Notary Public in <br />and for said county, person y came .3 bli-F)?ieria elL to me <br />known to be the identical person or persons who executed the foregoing release, and <br />acknowledged the same to be his, her, or their voluntary act and deed. <br />Witness my hand and - n said county, the day and year last wjritten ab <br />GENERAL NOTARY - State of Nebraska <br />KIM OSBORN <br />- My Comm. Exp. October 31, 2022 <br />Notary Public <br />