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200307828 <br />owned by V Lh r-1 6 d A-- <br />of a total value of' <br />—[/�h- �� o .�5� -•- ®w �1. :�� "� 4 i -r s�(� lar�� v <br />($ �Y-341 7� ) of which there remains unpaid $ 71J (9 , surd <br />furnished the first of the items on �a-dr^ f 5 - ��0�� (yeah and the last of' the <br />items on 4 -�� � �� � (year) and (if the lien is claimed by one nol in <br />privity with the owner) that the lienor served his notice to owner on <br />(year) by <br />(Method of Service) <br />and, (it' required) that the lienor served copies of the notice on the contractor on <br />(year), by and on the suhcontractor <br />(Method of Service) <br />Oil <br />By <br />(year), by <br />(Method or Service) <br />Li nor <br />Agent <br />State of 1167-7 l <br />County of Hid LC f <br />On a,01 ;2-a03 be ore me, <br />appeared ,Lc-z-- ,EGLt - -- e <br />personally known to me (or proved to me on the basis of satisfactory evidence) to be the person(s) whose names) <br />is /are subscribed to the within instrument and acknowledged to me that he /she /they executed the same in his /her /their <br />authorized capacity(ies), and that by his /her /their signature(s) on the instrument the person(s), or the entity upon <br />behalf of which the person(s) acted, executed the instrument. <br />WITNESS my hand and official seal. <br />Signature I- - <br />Signature or Notary Affiant Known ✓_ProducQd lD <br />Type of ID <br />6ENERAI. NOTARY - State of Nebreilci (S ca I ) <br />DEVICE R. KRUSE <br />* Carne. EV. Sept. 25,20M <br />Page 2 <br />1 <br />Ir <br />I <br />