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145 - CONSTRUCTION LIEN Jacob North Printing Co., Inc., Lincoln, NE 68524 <br />C) <br />M > <br />n rn cn <br />z <br />C=31 C) 3: cz <br />—4 <br />(A M > C= 1710 <br />m <br />CD <br />C-D <br />=D <br />Cn Cn <br />D- <br />CD <br />ch <br />CONSTRUCTION LIEN <br />200314125 <br />1. The real estate subject to this lien is: <br />q <br />-N <br />/C46et <br />2. The person against whose interest the real estate the lien is claimed is- <br />3. The name and address of the claimant is: <br />4. The name and address of the person with whom the claimant contracted is: <br />ke" <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 />6. (Complete one of the following) <br />— The amount unpaid, whether due or not, to the claimant for the services or materials is $ 22ff <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 40 IJ--15> <br />V <br />The time the last services or materials were furnished has yet cu ed but 1s l mated to occur <br />\_ f <br />���� <br />X, <br />tell <br />ignature of Claimant <br />Subscribed and sworn to before me this day of 2 C (7 <br />GENERAL NOTARY- sm of N&aska <br />& No <br />SANDRA DUGAN <br />44-8 My Comm. Exp. Aid 5, W Notary Public <br />(52-147. See 52-148 for amendment; 52-149 for assignment; 52-137 for recording time; 52-154 for discharge or release). <br />