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Pzi <br />rn <br />- nc <br />1>v <br />nN <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 />nn <br />Z i> <br />N <br />ao <br />I, 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: 1316 Walnut St, Wood River, NE 68883 , and <br />legally described as: LOT 9 IN BLOCK 1, DODD & MARSHALLS OF WOOD RIVER, HALL COUNTY <br />NEBRASKA which property is owned by Pamela Kimminau , whose address is 1316 Walnut St, <br />Wood River, NE 68883 , of a total value of $ 7,536.00 , of which there remains unpaid $7,536.00 , <br />and I further state that I furnished the first of the items on the date of September 16, 2022 , and the <br />last of the items on the date of September 16, 2022. <br />I hereby, under the laws of the State of Nebraska, claim a lien against the above-described property in <br />the amount of money, stated above, which remains unpaid to me. r <br />144/ate <br />Signature of Person Claiming Lien Of White Castle Roofing & Contracting <br />Name & Title of Person Claiming Lien <br />Subscribed and sworn before me this Ol I f-4- <br />day of Deattirthefr , .,0a <br />'GABBY MOLINA <br />. General Notary State of Nebraska <br />My Commission Expires <br />Seal ( Auoust f, 2023. Notary Signature <br />r��: <br />r - °- t <br />2 <br />r -r -t <br />r\r" <br />rV :y <br />Iv <br />co r_' i <br />ca <br />