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<br />ISTRUCTIONLIEN
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<br />.___.._ Jacob North Printinll Co.. Inc.. Lincoln. NE 68524
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<br />200610443
<br />
<br />CONSTRUCTION DEN
<br />
<br />1. The real estate subject to this lien is: MODULAR UNIT ADDED TO STOLLEY PARK ELEMENTARY SCHOOL -
<br />1700 WEST STOLLEY PARK ROAD - HAGGE'S SUB TO CITY OF GRAND ISLAND, LTS 28-29-30-31-32,
<br />HALL COUNTY, NEBRASKA. .." / I j) ..1 j
<br />2. The person against whose interest in the real estate the lien is claimed is: Jc:lIPt1 IT n."t. r
<br />Y'()tphS'f- I (t!:J/te,,) R'r 114/1 ~c</z./'7 I ~7~4f! t9;1' ~/Z~;"J K-'7
<br />3. The name and address of the claimant is: TOM SOUKUP, DBA SOUKUP I S HEATING & AIR CONDITIONING,
<br />INC., PO BOX 5432, GRAND ISLAND, HALL COUNTY, NEBRASKA 68802.
<br />
<br />4. The name and address of the person with whom the claimant contracted is: KEVIN LOCKHART. 4612 DEVA
<br />I
<br />
<br />DRIVE, GRAND ISLAND, HALL COUNTY, NEBRASKA 68801.
<br />
<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: PROVIDE AND INSTALL HEATING AND COOLING
<br />
<br />UNITS (2) TO THE MODULAR CLASSROOM UNIT PLACED AT STOLLEY PARK ELEMENTARY SCHOOL.
<br />
<br />6. (Complete one of the following)
<br />
<br />~ The amount unpaid, whether due or not, to the claimant for the services or materials is $ 1. 716 . 51
<br />
<br />~ The unpaid amount is not fixed by the contract, but a good faith estimate in the amount of $
<br />
<br />7. (Complete one of the following)
<br />
<br />....xJL The time the last services or materials were furnished was SF.'P1'F.MRER R, 7.006
<br />
<br />~ The time the last services or materials were furnished has not yet occurred but is estimated to occur
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<br />(/I IL"kJ /L4,. /
<br />~e of Clmmant--::-1'/ :/ ('c v'
<br />/ 1101"-4'5 .J &1 t1 ('- '1 iJ
<br />
<br />Subscribed and sworn to before me this
<br />
<br />i:!9J- n c( f- day of 0\1 (" h) be (" , (;) O{~,
<br />__J~jJtLQL-0 I .
<br />Notary Public
<br />
<br />
<br />J. GENERAL NOTARY. State of Nebraska
<br />I DOREEN KOSMICKI
<br />.. , My Comm. Exp. Aug. 19,2009
<br />(52-147. See 52-148 for amendment; 52-149 for assignment; 52-137 for recording time; 52-154 for discharge or release).
<br />
<br />all that part of Hagges' Subdivision of part of the Northeast~uarter of the
<br />Northwest Quarter and part of the Northwest ",uarter of the Northeast Quarter
<br />of Section 28 in TownShip 11, North, Range 9 West of the 6 P. M., lying West
<br />I ot the West ~ine ot William Street in said Subdivision Extended South to
<br />~~_~ou~",_~~....~~..~~~~~/~I~vn, J~!~MIt<< Lots ~~to 32, -both l()~_lIm!YL___ r
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<br />----.-...---.-....-.--.--...----"...."" '"''''-+1''--'''
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<br />Rev. 9/95 ! I
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