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`� � � n <br /> m � D <br /> T <br /> � � � � � � A N <br /> = 4 2 � � ca °c a � <br /> � � � N � � � -�-� m �� <br /> i m <br /> � F � �O� F-+ � o �ro <br /> ° w ° �' ca o <br /> � � � Z ~ � <br /> � � � � rn <br /> rn + J � D m � vyi <br /> i � 7 � � r" Z � <br /> V� r js �j � <br /> N <br /> `) � • � C"� v v O 3 <br /> ` 10-3 Forms. � N � � <br /> 10-3(a) p <br /> 99 108205 <br /> CONSTRUCTIUN .1� � <br /> i. Th al sta e,s hject ,v this lieQn pis; � ` ` <br /> , • �' i � St�N1 -i0�.. � <br /> 2. 'I'he erson ainst whose interest in the reai estate the lie�i is claimeel is: <br /> �� <br /> ��,k.�� <br /> 3. 'I�he narrie and d�ir ss o tlle daitiiant is: �er_r---_roc� _ ._ _ <br /> __`�1,0!`�; , � c , ,rr��er �.�� --�- <br /> -�. '1 n��� e ancI acidress�„,!,���A��nn ��'t(z ��• , „rlle claim: contr ct _� <br /> -���- _�8�.( . �,_� ;s: <br /> 5. A general descriptiors of the claimani's sen•ic:es E�erfonTied ur to be perf� iiecl c�r rt�a eri Is fur- <br /> ci;shed or to hy f rnished i�,r the ' �iprov �ieii a� �! ifie Conlric E�rice is: /� <br /> 1�__�c�c�i� �+1��_0� ��^Clr+e�--��:.�s <br /> C' -- -- <br /> -'`_- �- '��Q_� q tC- '��t�/_ _ �� � <br /> ��� - -�-�-�1�-�--- _ _ <br /> �,�.� <br /> 7�hc total cor�tra�t �•e�ce is��3��4Z <br /> 6. (Complrte c�ne of the foliowing? <br /> 'I'lie ame�u �t u�yE�aicl,�.•hrther�ilie��r not, 1�, �lie cl:�imant Cor the sen�iies t�r n:aterials is: <br /> ��--�-�r��4� �14s t wt�c��.--� <br /> �I�lic unE�aid �tttount is not lixe�l h�• ihe Ca�it�.ut. Lut a good faith r_stitnate in the am��unt <br /> s of: $.— ��_ , . <br /> t �• (Cvm��ie�r one o!the lollcn�•ing) ' <br /> ; ________"i�he time tlie last ser�ires c,� r,iateri,ils titi•ere furnisheu �vas <br /> ' �-.24-�q --- -- --- <br /> 'fhe tinie the last sr�viccs or itiatcri:ils ivf�re(uniislied hae nut}�ct i�ccurreel but is rstimateci <br /> ; to occur <br /> ; -- ---- — - -- --- <br /> � <br /> ; <br /> (;fain�� . <br /> 1 <br /> � ' - _ _� .__� <br /> � fts: _ -� - ---- <br /> Sub�crihecl and s�ti•cint t�he(ore nie this � c <br /> �,..�_—.clay c�( _ _.._ �,{,p�_, I9 1 f�, <br /> "��6'Eil£PJl1.MOTARY-Shq of Nebr2sk� <br /> DEBOfiAt1 J.PJOR�IAAN OZ/)fLCb+� <br /> MyCo�rtre.E�.8eDL19.20Qt N��t.ir�• 'uhlir _ - - - <br /> t�-6 <br /> September, 1995 <br /> "y <br /> •t <br />