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M = a �' rn <br />M CA C) rr t7 rw— ry r� <br />C' rn a N rn 1 r � C) c� <br />■�■ / n n CA `_ ry Ca -n o <br />Cn <br />Cn <br />ry c N Z <br />4 <br />�1�Tx 200507012 <br />1. I he real estates 6 Gbjca to the lien is: 1312 4) SCNj,%j-r� <br />S-� <br />2, TA legal description is as fat Iows: w-x-x= I] t fc!"Z -1w <br />3. The pe °con aga inst whose immst in the real estate the lien is claimers: <br />4. The nxm and address of the clairniiat is o,P,k L ''; r� �! j312cfC � 12 <br />Roofing Suppiy Grotto Inc. 131 i,q _SCOL•`rZ- Cz ►7 <br />2624 Edward )Babe Oome.2 Ave. NVG <br />Omaha, Nebraska; 68107 <br />5. The name and address of the person with whom the claimant conmicted is: <br />Presource Roofing <br />211 West Franklin <br />Centcmile, Ohio X454:9 <br />6_ 0 1-,Ancral dewriptior of the cla;atant's servLces performed or to bm Necforred.. <br />Or rmterials famished or to be fuaT. shed for *,c: irnpro , em: t ;,nd the contract prig is: <br />Rooting Suppli:s <br />7. Toe arnount unpaid. wttethcr due or not, to the ciaitr" :or the services or <br />nazterials is: 4 ,Z v/0. "i <br />8. The time the last ser`:re5 or materials were fuTnishe:d was: <br />Vu 4 .SA Y C zc>�, P r,i r'. <br />f'F.NT ^ NA11,11L <br />S "f A.'TE OF NEBRASKA Title <br />a� <br />CO(JNT :' OF D(� S ) <br />SUBSCR'DED AN73 SWORN to before ±;te this2s�Ld; <br />