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rn <br />G n= <br />z 7. <br />rn vs <br />e <br />0- <br />c- <br />co <br />Requested by: Mike Hansen <br />When Recorded Mail to: <br />Name: 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 />CJ <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: 4251 Utah Ave, Grand Island, NE 68803 , and <br />legally described as: LOT THREE (3) CAPITAL HEIGHTS EIGHTH SUBDIVISION, IN THE CITY OF GRAND <br />ISLAND, HALL COUNTY, NEBRASKA which property is owned by Dawn & William Arnold , whose <br />address is 4251 Utah Ave, Grand Island, NE 68803 , of a total value of $ 14,387.00 , of which there <br />remains unpaid 514,387.00 , and !further state that I furnished the first of the items on the date of <br />April 27, 2022 , and the last of the items on the date of April 28, 2022. <br />I hereby, under the laws of the State of Nebraska, claim a lien against the above-described property in <br />the mount of rrtioney, stated above, which remains unpaid to me. <br />Signature of Person Claiming Lien <br />Subscribed and sworn before me this <br />GABBY MOLINA <br />General Notary. State of Nebraska <br />Seal My Commission Expires <br />Auoust 1.2023. <br />i ke kInsen - ,4 cscie4,, - <br />Of White Castle Roofing & Contracting <br />Name & Title of Person Claiming Lien <br />day of -Aut.9 144- , aaaa <br />Notary Signature <br />rri <br />rn <br />ry -- <br />Z <br />o tr) <br />r <br />r\--) <br />c <br />cocri <br />6-1 <br />co Cr <br />