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145 - CONSTRUCTION LIEN Jacob North Printing Co., Inc., Lincoln, NE 68524 <br />rn CD,, �•� �� rr <br />r <br />•. <br />C0 <br />2 3 <br />CD <br />Z <br />CONSTRUCTION LIEN <br />1 � <br />200400646 <br />1. The real estate subject to this lien is: N 1/2 of the SW 1/4 of Section 23 township <br />12 range 10 W of the 6th P.M. <br />2. The person against whose interest in the real estate the lien is claimed is: Robert L. Siemens and <br />Marcia L. Siemers <br />3. The name and address of the claimant is: Scott L. Martin, 545 Eagle Road, St. <br />i <br />Libory, NE 68872 <br />4. The name and address of the person with whom the claimant contracted is: Marcia L. Siemer s <br />3 <br />i <br />5. A general description of the claimant's services performed to, to be performed or materials furnished or to be <br />furnished for the improvement and the contract price is: Concrete foundation for and <br />j addition of room to modular home, c antrant price $17.,515-00 <br />i <br />1 6. (Complete one of the following) <br />X The amount unpaid, whether due or not, to the claimant for the services or materials is $ 6, 5 6 4 . 0 0 <br />The unpaid amount is not fixed by the contract, but a good faith estimate in the amount of $ <br />i <br />1 7. (Complete one of the following) <br />— X The time the last services or materials were furnished was November 1 , 2 0 0 3 <br />The time the last services or materials were furnished has not yet occurred but is estimated to occur <br />j <br />i <br />i <br />1 <br />Signature of Claimant <br />yJ /(k <br />Subscribed and sworn to before me this ?< day of �� -� �t -� ! . <br />r <br />GENERAL NOTARY -State of Nebo aska <br />PAULA J. RODR GUE Notary Pub ' <br />9 My Comm. E�. - <br />1 (52 -147. See 52 -148 for amendment; 52 -149 for assignment; 52 -137 for recording time; 52 -154 for discharge or release). <br />i <br />I <br />t � <br />