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V LIEN <br />CONTRACTING OWNER OR SUCCESSOR IN <br />INTEREST: <br />v- '°- ------- --------------------------------- - - - - -- <br />(Name) <br />�------------------------------------------------------------- - - - - -- <br />P���cr�n������ CS "FSyIL. <br />CLAIMANT: <br />-------- - - - --X s{ - - - - -- .-------------- - - - - -- <br />(Name) / <br />(r...G z <br />........... ....-!5 ......... ' i ........................ <br />(Address) <br />- / -,Aw- --------------------- <br />� �i��8s------------ - - - - -- ( FAG----------------------- - - - - -- <br />(Phone) <br />Jacob North Piing Co., I cwy Yppoln, NE 68524 <br />('9 <br />2i <br />—v m <br />q <br />�= <br />C::� <br />o � <br />° -� -' 2� <br />0 <br />.l s m <br />CZD L ' <br />C� <br />D M <br />°. <br />r <br />U' <br />C:� <br />Cil <br />U� <br />U <br />i <br />20030403E <br />1 <br />C <br />CONTRACTING OWNER OR SUCCESSOR IN <br />INTEREST: <br />v- '°- ------- --------------------------------- - - - - -- <br />(Name) <br />�------------------------------------------------------------- - - - - -- <br />P���cr�n������ CS "FSyIL. <br />CLAIMANT: <br />-------- - - - --X s{ - - - - -- .-------------- - - - - -- <br />(Name) / <br />(r...G z <br />........... ....-!5 ......... ' i ........................ <br />(Address) <br />- / -,Aw- --------------------- <br />� �i��8s------------ - - - - -- ( FAG----------------------- - - - - -- <br />(Phone) <br />Jacob North Piing Co., I cwy Yppoln, NE 68524 <br />—v m <br />q <br />�= <br />C::� <br />o � <br />° -� -' 2� <br />0 <br />.l s m <br />CZD L ' <br />C� <br />D M <br />U' <br />C:� <br />Cil <br />U� <br />U <br />i <br />20030403E <br />REAL ESTATE: <br />✓ /'n '� f -------------------------------------------- <br />(Legal Description) <br />------------...----------------------------------------------------- - - - - -- - -- ------------------ <br />_� ---------------- <br />CLAIMANT CONTRACTED WITH: <br />(Name) <br />3 23 S.... --------------------------------- <br />- / <br />(Address)-- ....�,. f .... - - -- - - ------------ <br />-------------------------- - - - -(� .y ------------- - - - - -1 <br />(Phone) <br />SERVICES OR MATERIALS FURNISHED BY CLAIMANT: ...... _ ' 5--- - - - -c? _ g ----?-� <br />---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- - - - - -- -------------------- - - - - -- <br />-------------------------------------------------------------------------------------------------------- - - - - -- - - - - -- --- ----------------------.. -- - - - - -- . .....---- - - - - -- ----------------------------------- - - - - -- -- -- - - - - -- <br />CONTRACT PRICE: $ -- ----- - - - - -- -------- - - - - --------------------------- AMOUNT UNPAID: $ <br />TIME LAST SERVICES OR MATERIALS FURNISHED: ............ .....�15Z-d S <br />State of ----- <br />/ SS. -- ------ - - - - -- (T - <br />�i- 11 ............ . .. County Signature of Claimant <br />(� % C 3 - - -_ - -- , before me a Notary Public in and for <br />On this .. ........... . . .... day of - -!�h 1. <br />said county, personally came -------------- --- ................................. to me known to be the identical person ox' <br />persons who executed the foregoing instrument, and acknowledged the same to be his, her, or their voluntary act anc <br />deed. <br />GENERAL NOTARY • State of Nebraska <br />DEVICE R. KRUSEQ7.c <br />My Comm. Exp. $W.25, 20M ------------------------------------------------------------------------ <br />- ------------------------------- <br />Notary Public. <br />My commission expires the-- - - - - -- day of. - -= .--------------- - - - - -- `✓'���.�G <br />STATE OF Iss. Entered on numerical index and filed for record <br />County of ....................................... ....... ......... .... ........... j in the Register of Deeds Office of said County the <br />-------- - - - - -- - - -- -day of_ ------------------- - - - - -> - - - - -- at-------------------------------- - - - - -- o'clock and . -------- ...---- - - - - -- minutes.-------------- - - -M.; <br />and recorded in Book-------------- ----------- - - - -of ------------------------- - - - -at page ............. ................ <br />------------------------------------------- - - - - -- .......................... - --Reg. of Deedd <br />By - - - -- ----------------------- - - - - -- .............. --- -- ------ - - - - -- ----- - - - - -- ---- Deput3t <br />x <br />f <br />I <br />