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223 CONSTRUCTION LIEN 6, ct, • 200409018 Jacob North Printing Co., Inc., Lincoln, NE 68524 CONTRACTING OWNER OR SUCCESSOR IN INTEREST: T L I— ------------------------ PtJ -- --- I ----- t� ---- ------------- --------------_--- (Name) ------------ ----------- --------------------- --------------- I --------------------------------------- CLAIMANT: ---- --------------- ----------------------------- (Name) - — --------------------- ---------------- - (Address,: -- --------------- ----- Ai --- ----- ---------------- ---------- ----------------- ------------ _ ----------------------- (Phone) REAL ESTATE: 1A_/ -_ - ----------------------------------------- (Legal Description) ---------- ----------------------------------------------------------------------------------------------- C ---------- ----------------------- CLAIMANT CONTRACTED WITH: ---------------------------------------------- (Name) ............ ?_ 6 A, ---- - --------_--------- ------- ------------------- --- (Address), -------_------ -------- -------------------- -- ------------------------ ---- --------------------------------------- (Phone) SERVICES OR MATERIALS FURNISHED BY CLAIMANT: - - ----- ----------- ___;cC --------------------- N_ ------------- As.j, ------- ---- - ----- c-S ---------- .. .... - ------ - ----- ----- -------- --- --- ------ IT L) -e CONTRACT PRICE: C --------------------------- AMOUNT UNPAID: --- y ------ ----------------------------------- TIME LAST SERVICES OR MATERIALS FURNISHED: - ---- --- - ----- --- ------- tl__, ---------- 0 --- -------------------------------- State of ------ ----- Ss ------------------- -------- � ...... -- Signature of Claimant ---------- On this --- -- --------- --day of -- ------ - -- ----- - --------------------------------- -------- I before me a Notary Public in and for said county, personally came __.G._.'...._`.__.. -. ----------------------------- -------- Z — --------- to me known to be the identical person or persons who executed the foregoing instrument, and acknowledged the s e to be his, her, or their, untary act and deed. GENEW NOTARY - State of Nebrdft --------- ---RONALD D. PETERSON -- -- ..... --------- --- My Comm. EV. March 28, 2007 Notary Public. My commission expires the...._.. - -.. ---------d - - --- -- -- -- - ----- ----- -------- I -------- ---- STATEOF ---------------- ----------- ----- -- ------- --- ------ - - -------- ss. Countyof - ------- --------------------- ------------- ----------------------- I Entered on numerical index and filed for record in the Register of Deeds Office of said County the --------- --- --- -day of- - -- - - -- --------------- ----------- ----------- .1 at-------------------- - - - - -- - --- - - - - -- o'clock and-- - - - - -- - - -- - -- -- - -- minutes ------- ------ - - -M., and recorded in Book -- -- ------------ ---- ---- of ----- - - - - -- - - - - - -- - -- - - -.at page ------------------- -- -------- ------- ------------- ----- ------------- -- --------------- - - -------- -- ---- Reg. of Deeds By --------------------------------- - ------------------------------- ---- -- -------- --Deputy Rev. 8/95 rn r) n r-o CL CD :C CD W C=) r rl _ " I W cz) Cqr co U) CD CD 1-_ Cil 00 CONTRACTING OWNER OR SUCCESSOR IN INTEREST: T L I— ------------------------ PtJ -- --- I ----- t� ---- ------------- --------------_--- (Name) ------------ ----------- --------------------- --------------- I --------------------------------------- CLAIMANT: ---- --------------- ----------------------------- (Name) - — --------------------- ---------------- - (Address,: -- --------------- ----- Ai --- ----- ---------------- ---------- ----------------- ------------ _ ----------------------- (Phone) REAL ESTATE: 1A_/ -_ - ----------------------------------------- (Legal Description) ---------- ----------------------------------------------------------------------------------------------- C ---------- ----------------------- CLAIMANT CONTRACTED WITH: ---------------------------------------------- (Name) ............ ?_ 6 A, ---- - --------_--------- ------- ------------------- --- (Address), -------_------ -------- -------------------- -- ------------------------ ---- --------------------------------------- (Phone) SERVICES OR MATERIALS FURNISHED BY CLAIMANT: - - ----- ----------- ___;cC --------------------- N_ ------------- As.j, ------- ---- - ----- c-S ---------- .. .... - ------ - ----- ----- -------- --- --- ------ IT L) -e CONTRACT PRICE: C --------------------------- AMOUNT UNPAID: --- y ------ ----------------------------------- TIME LAST SERVICES OR MATERIALS FURNISHED: - ---- --- - ----- --- ------- tl__, ---------- 0 --- -------------------------------- State of ------ ----- Ss ------------------- -------- � ...... -- Signature of Claimant ---------- On this --- -- --------- --day of -- ------ - -- ----- - --------------------------------- -------- I before me a Notary Public in and for said county, personally came __.G._.'...._`.__.. -. ----------------------------- -------- Z — --------- to me known to be the identical person or persons who executed the foregoing instrument, and acknowledged the s e to be his, her, or their, untary act and deed. GENEW NOTARY - State of Nebrdft --------- ---RONALD D. PETERSON -- -- ..... --------- --- My Comm. EV. March 28, 2007 Notary Public. My commission expires the...._.. - -.. ---------d - - --- -- -- -- - ----- ----- -------- I -------- ---- STATEOF ---------------- ----------- ----- -- ------- --- ------ - - -------- ss. Countyof - ------- --------------------- ------------- ----------------------- I Entered on numerical index and filed for record in the Register of Deeds Office of said County the --------- --- --- -day of- - -- - - -- --------------- ----------- ----------- .1 at-------------------- - - - - -- - --- - - - - -- o'clock and-- - - - - -- - - -- - -- -- - -- minutes ------- ------ - - -M., and recorded in Book -- -- ------------ ---- ---- of ----- - - - - -- - - - - - -- - -- - - -.at page ------------------- -- -------- ------- ------------- ----- ------------- -- --------------- - - -------- -- ---- Reg. of Deeds By --------------------------------- - ------------------------------- ---- -- -------- --Deputy Rev. 8/95