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<br />I II <br /> <br />,T~lr~..1'IO~LIJ,~!J_~"~" ..__._..___... _.__._ __ Jacob North Printing Co., Inc., Lincoln, NE 68524---1 -un <br />\~ ..--.:-----.--..------.-----.-....--------.----.----.--------.--...,--..---.....------.......-..----.-....... - '-r---I'I' ----- <br /> <br /> <br />~~ m nn Ii <br /> <br />~~ ()n~ !~ <br />~\, ~ ?:; ~ <br />t: ~:t <br />~~ <br /> <br /> <br />I\.) <br />is <br />is <br />O'l <br />is <br />O'l <br />O'l <br />(JJ <br />(JJ <br /> <br />~ <br />~ <br />~ <br /> <br />~ <br /> <br />-... <br /> <br /> <br /> <br /> c'''' <br /> c:,:, (") (I) 0 <br /> c::> 0 -l <br /> ~ <br /> :-"\~" c: }.>0- N <br /> C- % -1 <br />';:t;) ~ "- c::= -'I. rr1 c:> <br />r"1 ~",- r- -< 0 <br />G") ,'~ c:> <br />o"''t N 0 ..,., <br />-..J .." Z en <br />"Ti <br /> li :J: m I <br />0 )>- UJ 0 I <br />n'1 P.. ,~ ::n <br />n1 l :::.3 r- ';lJ en <br />0 r >- <br />fJ) (f) en <br /> ~ 7" <br /> :t> c..n <br /> f-' -- <br /> 0 (ft c..n <br /> c.n <br /> <br />200606655 <br /> <br />CONTRACTING OWNER OR SUCCESSOR IN <br />INTEREST: <br /> <br />'])oX'\nn?3_c_h.~\).Kn------n-----n.n....................n..-.----n- <br />(Name) <br /> <br />CLAIMANT: <br />__~.t.t\-~--He:t+.l.~-l\-ll'i(-CO-rrl~.!.~-on.'-n<j-IJ: reO' <br />_(~_~Il1_e~Ul~_.n_&o.S'~....;)b'---n___nnn_____n__n_n_n__.......... <br />.~~~~Y\dc_.J:hb.~______.Nt;...____________&_~_1>_Q_l___ <br /> <br />.(:~~}n~'Ii~.::'1~}~Z____n_............____nn ____n____nnnn________ <br />(Phone) <br /> <br /> <br />REAL ESTATE: (I..!~\ 'N. He.dct-e ) <br /> <br />_Nrrtb_~~_t'e.i'..~-..cr;..-*.k~-110f.t:h---\.~O--sr:e.~+.... <br />_~!f~*~~~~.~~~4:._h~~nC-1:nnB.lO-~l:;..-J~.mn---n- <br /> <br />~~st~~~~~::'(*e'~~ji <br /> <br />CLAIMANT CONTRACTED WITH: <br /> <br />_'J:::bn.___...~_ch_e.~'\K-n-n-n---n-----......-......---n----- <br />.(~_~Il1_e)_y_a.\_______'W_!_.._H.~\d_tJ-------------------_________._...... <br /> <br />_(~~_~~.~.~r.("-r\d..--I~-k~tx\....jv.l;:-----~<?~-)-- <br />~b=> n-l...jl"r';t~ ~ ~08-"'30<6). - 3uW \No\" <br />.. . - - '" <br />. L...~._.~_n ___n ____n_______;>O:'6.:~2s0::-i8-3-l:\ntu<Y'.lC~\: \ I <br />(Phone) <br /> <br />, I <br />'1 <br />I <br />I <br />i <br /> <br />I' <br /> <br />SERVICES OR MATERIALS FURNISHED BY CLAIMANT: .(:e_plQ~_e.L_bo..cl..t....\J_e.~\o-t---"'_\O:to.r.::........ <br />\N1~h....\l\\:.W----~~y\\On('---yY'-O\or:.....G1:S.c:-v.Y.\b\~--~njo.toC/n..~}e.~l\-t:nn~O.{'----n-n.-----.... ......_.___nn___1 <br />_5p?g..\a.\..___n()_f6.~c:_____\l_q-\_6.r......lJ.Y\O:m.t._.__CA..s.s_~X(\hltb..n___........___n_n______n______nn____n______._..............nn____n___n---I <br /> <br />CONTRACT PRICE: <br /> <br />7 1- 3C:: <br />$ _......O'.\.Q~____...,,)_________nnn.n. .......__ <br /> <br />______..........____________________.........________________________..........._____________________________________________________________.............______________________________.___._...._.... <br />.....__________________________un <br /> <br />AMOUNT UNPAID: $....'].b~_.3'S___nnn_________nn___.. <br />I <br /> <br />TIME LAS: S:VICES OR MATERIAIB FURNISHED,....Q[l'bt~~~mm:~:~~~~~ ,~c <br />State of N___h___..S.~n______n n -...........-1 ~%~~>&~\ ~ ~Q.~~ ert j II <br />)-\- \ ss. -s~- l-Cnn~~e:.:. ........-....------.---------- <br />________wq\Ln___n_________ __ ..........._______County Signature of lai nt I . Ii <br /> <br />On tIriBm .,,:;..7!.";;ay Of~....m . ,1' m.... ,mmmmm, 9(/1:; b,fo" m, a Nota" Public in and fo'; <br />said county, personally came __ n _~aA_Un:h_j2,", nJ,::;,WLt.J:j?"n.. .......__ ___n to me known to be the identical person oj <br />persons who executed the foregoing instrument, and acknowledged the same to be his, her, or their voluntary act an <br /> <br />deed. -:J:7!'JJ~d<<;;:j/J2f;:;dl <br /> <br />otary Pubhc. <br /> <br /> <br />My commission expires the___nm............___nn___day oL__n______n................nm...n______n_' <br /> <br /> <br />::~ :FJ... En_ on n=erirnl index and moo fo, ~ <br />mmmday oLmmmmmmmmm, atmmmmmmmmO~I:: '::ofI:::~:d:=ty:lll <br /> <br /> <br />and recorded in Book..._______nnnn__.........oL_________________n____.....at page.......________nn___________. j I <br /> <br /> <br />__...............n___nn__________.............__nn______________...........Reg. of Deed <br /> <br /> <br />By_____n______________............._______________...............________________...... Deput <br /> <br />III <br /> <br />! I <br /> <br />----,,===-=t:.l::::. <br />Rev. 8/951 i i <br />