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INQ <br />cn <br />CY <br />CC <br />)INISTRUCTION LIEN Jacob North Printing Co., Inc., Lincoln, NE 68524 <br />L-A <br />LP 0 (11 <br />rn :r > <br />rM X US <br />> <br />C-M <br />3: <br />wmx� LA <br />r L4 <br />C, —3 <br />Lr <br />Cf) <br />200505139 CD <br />cr- <br />0 <br />Cn <br />CONSTRUCTION LIEN W <br />1. The real estate subject to this lien is: <br />0 s <br />2. The person against whose interest in the real estate the lien is claimed is: A( <br />3. The name and address of the claimant is: J, A -A <br />The name and address of the person with whom the claimant contracted is: <br />5. A general description of the claimant's services performed to, to be performed or materials furnished or to be <br />furnished for the improvement and the contract price is: <br />Abu a6�� <br />6. (Complete one of the following) <br />— The amount unpaid, whether due or not, to the claimant for the services or materials is $ t;2 <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 ;6u:�k S <br />The time the last services or materials were furnished has not yet occurred but is estimated to occur <br />AP <br />-7-of Claimant <br />Si ature <br />Subscribed and sworn to before me this day of <br />NOTARY -s t doom <br />� <br />;GENERAL <br />RuzicKA ' <br />F S T ArEY Notary Pubic <br />My CorM m. Gip. May 10, 2W <br />(52-147. See 52-148 for amendment; 52-149 for assignment; 52-137 for recording time; 52-154 for discharge or release). <br />ti <br />R,,. 9/91 <br />