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145 - CONSTRUCTION LIEN Jacob North Printing Co., Inc., Lincoln, NE 68524 <br />t.�..� �,.... T = D <br />(� r M N c y <br />(7 M n tt: <br />w o —q CD <br />� 3 - <br />1 D _ N <br />rn <br />t2 <br />.f <br />y. <br />t� <br />CD cil <br />O <br />r <br />CONSTRUCTION LIEN <br />200310759 <br />1. The real estate subject to this lien is: X ©7— U �� /�' �' �`'� \ <br />Az <br />2. The person against whose interest in the real estate the lien is claimed is: / l ',�u�' �6 S <br />3. The name and address of the claimant is: ctJ <br />5—/ S— F_ � �- 34 <br />144i <br />4. The name and address of the person with whom the claimant contracted is: ?f�G!!���� <br />5. A general description of the claimant's services performed to, to be performed or materi4ls furnished or to be <br />furnished for the improvement the contract price is: <br />/and <br />// _/ ,[�� <br />. <br />17 / � 1 �{ iy r? � � lJ 7� c.� 0 U � 7 � i �-f P A 7� / �C L>1 -i-G Ci'1 <br />� <br />s� /f 4 w" s4f' i� �/��,C <br />6. (Complete one of the following) <br />The amount unpaid, whether due or not, to the claimant for the services or materials is $ <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 0,9 e S � 0 3 <br />The time the last services or materials were furnished has not yet occurred but is estimated to occur <br />t �y /1 <br />l�.,- o�J <br />I Signature of Oaimant <br />L. <br />Subscribed and sworn to before me this day of <br />G - State 01 NefNaeka <br />DENICE R MUSE Notary Public <br />j My Comm. E= Sept. M 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 />i <br />I <br />i <br />i <br />Rev. 9/9 <br />