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• ' "' 200409815 Claim of lien ............................................................................................................................. ............................... State of Nebraska County of Hall Before me, the undersigned Notary Public, personally appeared McElroy Service Co. who duly sworn says that he is (the lienor herein) (the agent of the lienor herein) whose address is 807 Claude Road, Grand Island, NE 68803 and that in accordance with a contract with Kevin Woodward (Woodward Construction) lienor furnished labor, services or materials consisting of: (Describe specially fabricated materials separately) Furnace, Air Conditioner, Fabricated Ductwork and Labor to install on the following described real property in Hal 1 County, State of Nebraska (Describe real property sufficiently for identification, including street and number: Single Family Residence at 910 E South , Grand Island, NE 68803 by Kevin Woodward of totalvalueof Six Thous. Two Hund. Thirty Five Dollars($ 6235.00 ) of which there remains unpaidF n, i t T h n u s_ F i g h t H u n d_ F i g h t P P n Dollars ($ 4 818.0 0 ), and furnished the first of the items on April 20 , 20 04 and the last of the items on June 28 , 20 04 and (if the lien is claimed by one not in privity with the owner) that the lienor served his notice to owner on 0 c t o b e r 12 , 20--D4--by Certified Return Recept Reg.uested (Method of Service) And, (if required) that the lienor served copies of the notice on the contract on 20 , by (Method of Service) on 20 , by lender , on Page 1 and on the subcontractor and (if known) on the by (Method of Service) www.socrates.com m 2004, Socrates Media, LLC LF136 • Rev. 04104