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<br />200600951 <br /> <br /> <br />J.I A l t. County, State of <br />roperty sufficiently for identification, including <br />~MJ.1> ~S"(N.J <br /> <br />owned <br />by :5MTT ;t. KllrllY LAtUS ofa <br />total value of Dollars ($ ) of which there <br />remains unpaid ON ~ 1flJ~YJ!..ej) ''-l~W/UlJfY Dollars ($ (~~. tJt) ), and <br />furnished the fi\st of the items on ::JflN. ;Zy ,200(., and the last of the items on <br />"(fA.\.) dL4' , 20~, and (if the lien is claimed by one not in privity with the Owner) that the <br />lienor served his or her notice to Owner on Fef3. 3 , 20 c G , <br />by ~eR..ri F ie D mf}.t'C <br />(method of service), <br /> <br />(method of service), and <br /> <br />,20 <br />(method of service). <br /> <br />, 20 -L!..i.-. <br /> <br />State of: -1J{2b f <br /> <br />County of: ~ Q \ \ <br /> <br />On bb -3 ,~OO(P ,beforeme,_4\f1r\D -5 -=t='"and r~ ' <br />appeared ~ \ () ~ CI (" 'J r Ll f(\ 11\ L f\tf: .:S , personally known me (or proved <br />to me on the basis of satisfactory evidence) to b he person(s) whose namei?l is/are subscribed to the within <br />instrument and acknowledged to me tha@he/they executed the same i@her/their authorized capacity(ies), <br />and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the <br />person(s) acted, executed the instrument. <br /> <br /> <br />GENERAl NOTARY. State of Nebraska <br />KARLA S FANDRY <br />My Comm. Exp. Feb. 17, 2009 <br /> <br />Affiant Known_Produced ID <br />Type of ID <br />(Seal) <br /> <br />www,socrales,com Page 2 of 2 <br /> <br />@ 2005 Socrates Media, LLC <br />LF 136.1 . Rev, 0210S <br />