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<br />Jacob North Prlnti~~~~~L~I!l.~oln" NE 68524 ,..___ --.,,1..,.-____
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<br />~STRUCTION LIEN
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<br />CONSTRUCTION UEN
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<br />200706772
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<br />5,
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<br />1. The real estate subject to this lien is:
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<br />125 PONDEROSA. GRAND ISLAND. NE 68803
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<br />(LOT ONE, BLOCK TWO IN PONDEROSA LAKE ESTATES THIRD SUBDIVISION IN THE CITY OF GRAND
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<br />ISLAND, BALL COUNTY, NEBRASKA)
<br />2. The person against whose interest in the real estate the lien is claimed is: BENJAMIN SHAFER
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<br />3. The name and address of the claimant is: SOUKUP'S HEATING & AIR CONDITIONING, INC.,
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<br />PO BOX 5432, GRAND ISLAND, NE 68802 / TOM SOUKUP, PRESIDENT
<br />THERESA SOUKUP, VICE PRESIDENT
<br />4. The name and address of the person with whom the claimant contracted is: BENJAMIN SHAFER,
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<br />125 PONDEROSA, GRAND ISLAND, NE 68803
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<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: INSTALL HEAT PUMP AND DUCT WORK,
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<br />$654.00, DATED 01/16/07, INVOICE # 2245, PLUS INTEREST
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<br />6. (Complete one of the following)
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<br />...xx....- The amount unpaid, whether due or not, to the claimant for the services or materials is $ 721.15
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<br />_ The unpaid amount is not fixed by the contract, but a good faith estimate in the amount of $
<br />7. (Complete one of the following)
<br />XX The time the last services or materials were furnished was JANUARY 16, 2007
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<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~x1Jfl Vice tl'SJde,
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<br />Signature of Claimant
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<br />Subscribed and sworn to before me this
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<br />g,zfL
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<br />GENEIW. NOTARY - State of N ..- .-- 7
<br />RONALD o. OCHSNER Notary Public
<br />My Comm. &D. Feb. 14, 2009
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<br />(52-147. See 52-148 for amendment; 52-149 for assignment; 52-137 for recording time; 52-154 for discharge or release).
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<br />--111
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<br />,,__.__.____......__m..._..."'......_____,_ --.....-,..._.~~-~." 9/95 ----tr--_
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