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<br />STATE OF NEBRASKA
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<br />DATE:
<br />WIVOK W.11INAII1.7 nova
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<br />April 1. 1, 2005
<br />Middleton Electric, Inc.
<br />2716 West Old Highway 30
<br />P.O. Box 447
<br />Grand Island, NE 68802 -0447
<br />Schafer Medical Two, L.L.C.
<br />1004 Diers Ave, Suite 140
<br />Grand Island, NE 68803
<br />TOM MIDDLETON, duly elected President of Middleton Electric, Inc., a Nebraska
<br />corporation, being first duly sworn upon oath, deposes and says:
<br />1. He is the duly elected President of Middleton Electric, Inc., a Nebraska corporation
<br />and as said President verifies this account in writing for and on behalf of said corporation.
<br />2. Middleton Electric, Inc., by and through its duly authorized officers, entered into a
<br />contract with Doug Luth, to provide labor and materials for the electrical requirements relating to
<br />construction of a restaurant store upon the real estate hereinafter described and the contract price
<br />for the improvements constructed upon such real estate by Middleton Electric, Inc. totaled
<br />Sixteen Thousand Eight Hundred Sixty -Nine and 00 /100 Dollars ($16,869.00).
<br />3. Said Doug Lath entered into this contract for and on behalf of Schlotzsky's Deli.
<br />4. The materials and labor were provided upon and in respect to that real estate located at
<br />Grand Island, Nebraska, legally described as follows, to -wit:
<br />Lot Four (4), Crane Valley Fourth Subdivision, Grand Island, Hall
<br />County, Nebraska.
<br />5. The amount unpaid and due to Middleton Electric, Inc. for materials and services
<br />provided in accordance with the contract through December 1.4, 2004, at Sixteen Thousand Eight
<br />Hundred Sixty -Nine and 00 /100 Dollars ($16,869.00) together with interest thereon as provided
<br />by applicable law.
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<br />CONSTRUCTION LIEN
<br />110 IS
<br />April 1. 1, 2005
<br />Middleton Electric, Inc.
<br />2716 West Old Highway 30
<br />P.O. Box 447
<br />Grand Island, NE 68802 -0447
<br />Schafer Medical Two, L.L.C.
<br />1004 Diers Ave, Suite 140
<br />Grand Island, NE 68803
<br />TOM MIDDLETON, duly elected President of Middleton Electric, Inc., a Nebraska
<br />corporation, being first duly sworn upon oath, deposes and says:
<br />1. He is the duly elected President of Middleton Electric, Inc., a Nebraska corporation
<br />and as said President verifies this account in writing for and on behalf of said corporation.
<br />2. Middleton Electric, Inc., by and through its duly authorized officers, entered into a
<br />contract with Doug Luth, to provide labor and materials for the electrical requirements relating to
<br />construction of a restaurant store upon the real estate hereinafter described and the contract price
<br />for the improvements constructed upon such real estate by Middleton Electric, Inc. totaled
<br />Sixteen Thousand Eight Hundred Sixty -Nine and 00 /100 Dollars ($16,869.00).
<br />3. Said Doug Lath entered into this contract for and on behalf of Schlotzsky's Deli.
<br />4. The materials and labor were provided upon and in respect to that real estate located at
<br />Grand Island, Nebraska, legally described as follows, to -wit:
<br />Lot Four (4), Crane Valley Fourth Subdivision, Grand Island, Hall
<br />County, Nebraska.
<br />5. The amount unpaid and due to Middleton Electric, Inc. for materials and services
<br />provided in accordance with the contract through December 1.4, 2004, at Sixteen Thousand Eight
<br />Hundred Sixty -Nine and 00 /100 Dollars ($16,869.00) together with interest thereon as provided
<br />by applicable law.
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