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i <br />145 - CONSTRUCTION LIEN n f1 Jacob North Printing Co., Inc., Lincoln, NE 68524 <br />C�T C M N <br />CD <br />O <br />cn <br />F� .✓ <br />N U'1 <br />Cn <br />i CONSTRUCTION LIEN <br />�- 200304915 <br />1 r <br />1. The real estate subject to this lien is: � Q to a� S�(.AAP r mnsVI A A (L <br />eta AN PI, 5� . Laabo- . Lal Y mPds,Pc A- LA suk - mil; <br />2. The person against whose interest in the real estate the lien is claimed is: T)r . c T -T C. h k e r+ <br />3. The name and address of the claimant is: �- nS 1 e�F i e c-- r �i ca ` S P r U i C e S T n C <br />�� Aa C-rf -a � �i a � 1�� iI S <br />i C 1 <br />4. The name and address of the person with whom the claimant contracted is: S M AI-, (&(- -YST (-uC ` 0r1N <br />, <br />e-k-If �nr-,;� 3 \� F, \ ?) L C- a fyC, �J C, r, 1A �Jj <br />5. A general description of the claimant's services performed to, to be performed or materials furnished or to be <br />i <br />furnished for the improvement and and the contract price is: <br />(n� <br />�iJ�r'i'11S�P1'i mCA erin � `Cunt- -tsr P\ec--�Y"!ccL. Lk3Or -k <br />6. (Complete one of the following) <br />i <br />The amount unpaid, whether due or not, to the claimant for the services or materials is $ iUn. <br />i <br />The unpaid amount is not fixed by the contract, but a good faith estimate in the amount of $ <br />7. (Complete one of the following) <br />The time the last services or materials were furnished was l 1CLP C rl.�i� <br />The time the last services or materials were furnished has not yet occurred but is estimated to occur <br />��dAl�tHY-Sta� of Nebo <br />CAROL A. NELSON <br />A1y Coma.. fxp. May 5, 2005 Signature of Claimant <br />Subsribed and sworn to before me this day of . <br />i <br />to Pub 'c <br />(52 -147. See 52 -148 for amendment; 52 -149 for assignment; 52 -137 for recording time; 52 -154 for discharge or release). <br />i <br />I <br />i <br />t <br />i <br />