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ti 200409814 <br />Claim of Lien <br />............................................................................................................................. ............................... <br />State of Nebraska <br />County of Hall <br />Before me, the undersigned Notary Public, personally appeared McElroy Service Co. <br />who duly sworn says that he is (the lienor herein) (the agent of the lienor herein) whose address is 807 <br />and that in accordance with a contract with <br />lienor furnished labor, services or materials consisting of: (Describe specially fabricated materials <br />separately) Furnace, Air Conditioner, Fabricated Ductwork and <br />Labor to install <br />on the following described real property in H a 11 County, <br />State of Nebraska <br />(Describe real property sufficiently for identification, including street and number: Single Family residence <br />at 904 E South, Grand Island, NE 68803 <br />Block 1 Lot 5 Parcel 400449870 <br />by Mi rhaPl & St»annP T.i 1 i enthal of <br />totalvalueofFi VP Thnns _ Ri qht Htind Pd Eighty Five Dollars($ 5885.00 ) <br />of which there remains unpaid One Thous. Five Hund. Thirty Si)Dollars($ 1536.65 ), <br />and furnished the first of the items on January 1 9 , 20 04 and the last of the <br />items on [ u np 2 R 20 04 and (if the lien is claimed by one <br />not in privity with the owner) that the lienor served his notice to owner on October 12 <br />20 04 by Certified Return Receipt Requested <br />(Method of Service) <br />And, (if required) that the lienor served copies of the notice on the contract on <br />20 , by <br />on 20 by <br />lender <br />, on <br />(Method of Service) <br />Page 1 <br />and on the subcontractor <br />and (if known) on the <br />by <br />(Method of Service) <br />www.socrates.com <br />m 2004, Socrates Media. LL <br />LF136 • Rev. 04104 <br />