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<br />! I <br />I, <br />11 <br />I! <br />j I <br />! I <br />! ! <br />I! <br />i I <br />! I <br />Ii <br />! i <br />Ii <br />i i <br />! I <br />: i <br />! I <br />: l <br />; I <br />; ! <br />Ii <br />Ii <br /> <br /> <br />-_._..----.-.._..~_...~._-------_._..__.- ---.----------..-.-.-.-.- .-....... ...........---........ ...- -..=#--.-.--- <br />I' <br />Rev. 9/9 i I <br /> <br />II I <br /> <br />NSTRUCTION LIEN <br /> <br />Jacob North Printing Co., Inc., Lincoln, NE 68524 <br /> <br />Cl~'~ <br />2~0 <br />~. /;'/1 C!'. <br />'l:S . Q.. <br />U ~ - <br />i) ~.~- <br />A' - ~- <br />~ ~ ~ <br />"""'.6 -. <br />~ J::i. ~ <br />\1\ 'e.J Q- <br />"". ~ <br />~. t:: <br />~j tl <br />~ r <br /> <br />- <br /> <br />200701234 <br />P )eUS4nTui-euJ '-/IA <br /> <br />5. <br />II ddtlfYL <br /> <br /> 10 I n n <br /> m ~:r. ):.. j"~...~ <br /> "'" ~ (") lfJ <br /> C rn (."1 <:.:::> 0-4 <br /> n ..... -..:. <br /> Z ....... c1> <br />(') ..... ,..':1,1.. <br />n 0 ;':", I -r, :;Z:-4 <br />:r 1 :;0 ~' r-T'l -1f'T1 <br />m )> cn ,i m "- CD -<0 <br />(") (f) I ~~- 0"'" <br />~ :J: I ~ <br /> ...., 0') """'z <br /> 7"-L :r: ,,1 <br /> 0 f' l> rrJ <br /> I m ::D i:::D <br /> m :3 i:t>- <br /> 0 <br /> I if) ~ (j) <br /> ~ c:::> 7" <br /> :t>- <br /> <...n ~'---" <br /> r'V (j) <br /> (j) <br />CONSTRUCTION UEN <br /> <br />N <br />iSl <br />(9 <br />-...J <br />iSl <br />-->. <br />N <br />W <br />4::>- <br /> <br />'"",--,- -.. <br /> <br />1. The real estate subject to this lien is: <br /> <br />L '> i-I <br /> <br />~I k..-I <br /> <br />2. The person against whose interest in the real estate the lien is claimed is: <br />Tim """ /ls 11 le.J If OfJtJI /' 5 <br /> <br />3. The name and address of the claimant is: B f) L .$;- J l4 ~ -I (;j r ,,& "U7..s. hI c?. '" <br />~tJ{, 0 5a/7daJu.lt!lt!JJ Or. U-/YilJt:lr"$-!afi.d I A/e 0 8Bo 3 <br /> <br />4. The name and address of the person with whom the claimant contracted is: 7':- nl. Rosers <br />g-03 E.- f1); oY/l1;c II V f?.. Gr4J7c1 .}: .5/4 /,.d J It/e. ~ 8"36 I <br />, <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: <br />Tu I' /1 } 6 A B ci ,L u bi!);' a J1..d. JrL~ -{ e r /d { /0 ; lJS-1ti I! /} (:, &c? <br />S I,in,ti le~ / ~/f 0.. nd. A4 (...(, I a w<<....1 d (!..bJ /S . <br />6. (Complete one of the following) <br />_ The amount unpaid, whether due or not, to the claimant for the services or materials is $ 'I LJ I> 'J( 517 <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 />_ The time the last services or materials were furnished was / j, 3 - t} b <br /> <br />_ The time the last services or materials were furnished has not yet occurred but is estimated to occur <br /> <br />~~/1/1IV1~ <br /> <br />Signature of Claimant <br /> <br />Subscribed and sworn to before me this <br />l~ GENERAl. NOTARY. State of Nebraska <br />Jill USA R. MAYER <br />_" My Comm.. Exp. May 10, 2007 <br /> <br /> <br />~a21 <br /> <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 />"lr~~" <br /> <br /> <br />i <br />i <br />I <br />I <br />I I <br /> <br />i <br />I <br />I <br />I I <br />I <br />I <br /> <br />; <br />! i <br />