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l <br />JSTRUCTION LIEN Jacob North Printing Co., Inc., Lincoln, NE 68524 <br />v M <br />^n 2 a <br />M CA <br />z CD <br />/`� 1ZPI n <br />m CA —4 rn Cf <br />2, , �� <br />- o <br />C.0 cn <br />000 C N �a `= -n ° <br />3w =� <br />C, <br />Co <br />:> <br />ll� � � <br />^' 200545887 ^'' <br />CONSTRUCTION LIEN 5`S. <br />1. The real estate subject to this lien is: 4. ° <br />Qc� LLG �fRQA �- <br />2. The person against whose interest in the real estate the lien is claimed is: <br />�n <br />3. The name and address of the cl ' ant is: cv-• Daft <br />4. The name and addre s of the person Nth whom the claimant is: <br />ffacted <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 />Q o G <br />cz � 414- q <br />��q rl�r+- v , <br />6. (Complete one of the following) <br />The amount unpaid, whether due or not, to the claimant for the services or materials is $ 14P <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 <br />The time the last services or materials were furnished has not yet occurred but is estimated to occur <br />�RECO t -Va Z-68 <br />Sign u Claimant <br />Subscribed and sworn to before me this d day of�� <br />GENERAL NOTARY SAM N86�ra <br />Notary Public <br />SHIRLV SCHUTTMANN <br />MY COM Exp. Nov. 4, 2M <br />(52 -147. See 52 -148 for amendment; 52 -149 for assignment; 52 -137 for recording time; 52 -154 for discharge or release). <br />Rev.9 /91 <br />