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<br /> __..°� � ' , .. .` _. TOTAX+. DUE $�,a�2.00` � � ; � . -- --
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<br /> _•--�..,::-x=0;,�.= . Afffant�. A�lan R. PeP�Br, atl�rneY anc� aqent fa� zs�latek I�nteriaatior�al,-
<br /> __�_-���� �41 F'ura�c�. S�re�t, Sta�opa. N� 07894, claimant; I�e�.ng ffrst duly sworn,�
<br /> .�.m�;� oa h#s oa�,h says �8t�� t8s- foreqoing ftemized account o� sp� :_on
<br /> ====-.�;.`: . g�e���f materia2. ��`ed. related a�te�i�ls. and iraprave�aent�� is, true., a2�8.
<br /> � +G� � corr��;- ,.t�hat saa[e at�re don�. anc� perfarmed and furni.&�ed h,�: ..the=
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<br /> _--_==-�°�,;,�?Y�.,�. undersigae�l for jth� s�id Therm Seal, .8Zi L�e, Clay center, RS 674�2_ aander
<br /> _=��:�:��w�tf',-�_; � '�� an ora� ccntract'�fo'r the con��tructioa and/or improvement of:�a bufld�.ng os� —
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<br /> '-`°��<<�;,;�,�ti�.�:;+� ,, the.fo�.l wfng.��t, Pi��e. or parce7l of land, vfz: - -
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<br /> ��.r`�r< .,;-:,,: ,. �{ .. ' pai:E,.'�el Il? �331S�C8di".�0-14681-000 0001 . -
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<br /> ����-�- .r .�.•,, • � 1 of ttae�S�.,`:���ancis Mea�3.aa1 Third Sui�divisfa�, �urther — --
<br />�s�'�'���� •-=���=':-�-:k�-� desar�ed in a L�at reaorded as Dccument Na. 93-103185 in Hall
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<br /> �_,�y:y,�;f:3:.;:;!.:,�� ��monly known as���t. Francis Med�.aal Center out �atie�t
<br />���;:r.���-�,� ��`���`- �'ervices Phase Y � II Addition & Rea[odel., 262o W. .Faid].ey
<br />�:'�:�:�+�>� t��:�; Ave., Grand Island, NE 68803 . . . -____-
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<br /> -:?r.-: �- '= That at the time said apntract was made and labor and/or materials , �� � _,-��
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<br /> r'`"'�"'� �� furn$shed and del3.ve�d thereunder St. Franais Hospi.tal was the owne�r of °__'�'-
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<br /> -����;����_'�1"x� '� said preaafs�s t that .;�ri Valley Builders was the :�on�ractor� on sa$d
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<br /> �;:•� �c�: �` ^ builciinq and actinq �'cz� the owner and �contracted wit� Therm Seal to whrna -
<br /> `� �"�`h� " � � Isolate3s Internatfcn�l .su,�pZ�.ed the above stated materia.2s. _ -=-
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<br /> � � , „n Th�t the date oP� fi.�s� fixst item furnished and de��wered 'was Feb�xaxy, v�� ",�=
<br /> +` � `';�` Z994 artd the date of �1'z� last item was March 27, 1994: [ ` -
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<br /> - � � • Affiant f�aather states that said labor was performed on, and mater�.a]:� ,�t4i t;:,:•��':����.:��"
<br /> ..�•�� ' � � were furnish�d �ar, delivered at, and used in said buildinq or .premises osz; � S�'���� . . ,•�.
<br /> • "; � and betsasen tke. dates speciffed. ,. '����,,�• ; ,.'�,�;.
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<br /> � � ' � ��� � � That the pricea charqed therefor are fafr and reasonable, artd that ; . ; . . �
<br /> ,k�� ' : ��'. there is noor due on said account the sum of SIX THOUSAND, FIVE HtJNDRED . `�� �<� � '
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