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<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 />       _=��:�:��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 />�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 />  	,k�� '  :  ��'.    		there  is  noor  due  on  said  account  the  sum  of  SIX THOUSAND,  FIVE  HtJNDRED  .  `�� �<� � '
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