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Excel Physical Therapy Clinic, Grand Island, Nebraska Legal: Crane Valley, 4`h Sub Lot Two (2) Block: O, Hall County, Nebraska 2. The person against whose interest in the real estate the lien is claimed is: (Contracting Owner) Shafer Development Joel Shafer 30 Ponderosa Drive Grand Island, Nebraska 68803 EIN: 47- 0832801 3. The name and address of the person with whom the owner contracted is: (Contractor) Miska Drywall Dean Miska 219 N. 22nd Street Ord, Nebraska 68862 EIN: 47- 0726045 4. The name and address of the claimant is: Miska Drywall Dean Miska 219 N. 22nd Street Ord, Nebraska 68862 5. A general description of the claimant's services performed or to be performed or materials furnished or to be furnished for the improvement of said real estate and the contract price is: Labor provided: Provided drywall services $2,117.00 Materials provided: $ 220.00 6. Complete one of the following x The amount unpaid, whether due or not, to the claimant for the services or materials is $2,337.00 The unpaid amount is not fixed by the contract, but a good faith estimate in the amount of $ 7. Complete one of the following x The time the last services or materials were furnished was: February 12, 2003. The time the last services or materials were furnished has not yet occurred but is estimated to occur Pagel of 2 June 5, 2003 rn }, U) rn N Cn N N CC) { cn v t E`- E ;I O CD N CY - - o CD � CD L, = V z C\J 4c li o C ;