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C M n [a <br />T M U <br />c <br />n z M <br />r' <br />= v ,.� <br />0 <br />J r 7C = ' z N fl. <br />�_ <br />M CD <br />`y/ l CM W <br />t X,J m <br />Fn <br />€' 2 <br />3 <br />�[ n co <br />CD <br />' 200311489 a vv co <br />�-� CONSTRUCTION LIEN ~ � CD O <br />1. The real estate subject to this lien is: �111,` <br />"G <br />2. The person against ((whose interest in� the �real estate the lien is claimed is: <br />Df ,�v^ -�A � =`ids <br />Q <br />The name and address of the claimant is-- <br />The name and address of the person with whom the claimant contracted is: <br />SVt,U1(gty��r <br />Z�,,4 s6 NC- (0992 3 <br />v <br />5. The general description of the claimant's services performed, to be performed, or materials furnished or <br />to be furnished for the improvement and the contract price is: <br />I _ ccwy S obC CAA c.rc. a -5-3 t--* <br />6. (Complete one of the following): <br />"K, The amount unpaid, whether due or not, to the claimant for the services or materials is <br />$ 714.5 <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 of the last services or materials were furnished was 2-003 <br />The time the last services or materials were furnished has not yet occuiVed but is estimated to occur <br />i <br />Signature of Claimant <br />atelmal a DD] tIT-11W M- <br />)ss <br />COUNTY OF WQ., ) <br />The foregoing instrument was acknowledged before me thisat'-day of , 20ff3 <br />by , <br />Of r,�_,,� C C _ Qt corporation, <br />on behalf of said corporation. <br />Notary Public <br />My commission expires: <br />W NERAL NOTARY • State o} Nebraska <br />VALERIE NIELSEN <br />My Comm, Exp, AUG 20, 2004 <br />