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<br /> Gl <br /> Q i'''',.....") ;11 <br /> ;;0 n ~ ~.':,"",,~:') 0 (n <br /> c:::..'") 0 i <br /> ::> m ~ Gl':JI 0 ..'1 <br /> \::, 'TI ""..,~ . c: :P <br /> C U) -,'- rv <br /> 0:. n :J: ':;> \, Z -1 f! <br /> z :t:' ':.':::> -I 1'1 <br /> n ;:x; r~' (.~.~ c::= a <br /> 0 " -< <br />I'\.:l bJ :c ~ G~ ~,' - 0 a- <br />CSl m ~ ''\'" 0 '1 a <br />CSl ';S. n en C) .... --J ~'1 <br /> ~11 ""'".~ (TJ <br />Q') ~ ~ :c Y\ :=x: i'''1'''1 <br />CSl ~J <br />co rr; (' -'0 l'" C::J 0 <br />co t. li"'1 ), ::3 r- .;;] <br />'""" t..;.',; r r- .1.:,:0.- CD <br /> U, I' U1 <br />W ~ \' C..) ^ CD <br /> ~ l> --J <br /> C) -- <br /> t-.} 0) c.n w f <br /> ::s ({1 <br /> 0 <br /> \ <br /> <br /> <br /> <br /> <br />200609973 <br /> <br />CONSTRUCTION LIEN <br /> <br />1. The real estate subject to this lien is: <br />L., .\.. <br /> <br /> <br />2. The person against whose interest in the real estate the lien is claimed is: <br />Jeremy Wiese <br />8462 West Wildwood DR <br />AIda NE 68810 <br /> <br />3. The name and address of the claimant is: <br />Gerhold Concrete Co. Inc <br />PO Box 13 86 <br />Grand Island, NE 68802 <br />(308) 382-2032 <br /> <br />4. The name and address of the person with whom the claimant contracted is: <br />Jeremy Wiese <br />8462 West Wildwood DR <br />AIda NE 68810 <br /> <br />5. The general description of the claimant's services performed, to be performed, or materials furnished or to be <br />furnished for the improvement and the contract price is: <br /> <br />Concrete and concrete products <br />$ 841.62 <br /> <br />6. <br />~ <br /> <br />(Complete one of the following): <br />The amount unpaid, whether due or not, to the claimant for services and/or materials is <br />$ 841.62 <br />The unpaid amount is not fixed by the contract, but a good faith estimate in the amount of <br />$ <br /> <br />7. <br />~ <br /> <br />(Complete one of the following): <br />The time of the last services or materials were furnished was: <br />08H25-06 <br />The time the last services or materials were furnished has not yet occurred but is estimated to occur <br /> <br />~~ 16~ ~LJ~ <br />Signature of Claimant <br /> <br />STATE OF NEBRASKA) <br />)ss <br />COUNTY OF Douglas ) <br />The foregoing instrument was acknowledged before me this \ day of _November, 2006 <br />Gilbert Wilson Manager <br />of Gerhold Concrete Co. Inc. , a Nebraska corporation, on behalf of said corporation. <br /> <br />J;ENERAL NOTARY. state of Nebraska <br />STACEY A. RUZICKA <br />'n' My Comm. Exp. May.10, 2007 <br /> <br />~ ~~~f\ ~,->----~c..~ <br />No Public <br /> <br />My commission expires: <br />