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<br />Jacob North Prlnllnll C.!hl'llh.blncoJ.!hRI;_68st<l <br /> <br />en <br /> <br />91 <br />C) I <br />Ii <br />200708050 " <br />J:! <br />Gr / N1 fj I-/D~" R ~ 11 a.Jr tAte. ill! <br />f . I <br />I <br />II <br />II <br /> <br />STRUCTION LIEN <br /> <br />~~r <br />~ 'i. ':/ <br />? \ ~ .~. . <br />~}; <br />~ ..' <br />" <br /> <br />Qo <br />m> <br />0<110 <br />~:I: <br /> <br />;0 <br />m <br />"TI <br />C <br />Z <br />O. <br />~'~ <br /> <br />(") ~ <br />:r <br />rn ",. ,-.;, <br />n :r: <::;:J <br />7l\ <::0, <br /> "--".t --.;J <br /> r........". (J) <br /> ;:Q ~~" r...., <br /> m -0 <br /> ~ 0 1::"""-- <br /> <:::> '''f ......... <br /> '0 ..." c::o <br /> IV t~~ <br /> r'1 t V <br /> ~l :3 <br /> <::l <br /> lfJ <br /> N <br /> -t:: <br /> -..J <br /> <br />N <br />CSl <br />CSl <br />-..J <br />CSl <br />co <br />CSl <br />(J1 <br />CSl <br /> <br /> <br />~, <br />~ <br />~ <br />~ <br /> <br />~.' <br /> <br />t <br /> <br />CONSTRUCTION LIEN <br /> <br />C')Cf) <br />0-1 <br />c: .1> <br />;z---! <br />-1 ["T1 <br />-< C:l <br />o Cj <br />." '..'.... <br />...- <br />::::t:. 111 <br />> en <br />r- ::0 <br />r l> <br />(fJ <br />;:>0;: <br />l> <br />""'-"''--"'' <br /> <br />(f) <br />{fb <br /> <br />Lot <br />ri ~ w~ Lbw"" (;;f <br /> <br />~()t <br />1. The real estate subject to this lien is: 1 'XS- Lv ~ L flwlU 61) <br />~4.)e.~;'f ;)cr+f2.12::.f 1- JK ((' A.Drj- <br /> <br />2. The person against whose interest in the real estate the lien is claimed is: <br /> <br />3. The name and address of the claimant is:---JJ02AJN,':> 5c ",./-/x.o K~y LiZ C I... nrk.f fiJ..?J,r <br /> <br />c g, 28' <br /> <br />4. The name and address of the person with whom the claimant contracted is: <br />Sa /t1,e 5 Q i l.l e r ().. //; iJ Z pJ Er1'J a.~ tN~ II C.,1. ~'fl.bl'. <br /> <br /> <br />o <br />N <br />C) <br />Q <br />~ <br />o <br />0) <br />C> <br /> <br />,,~ <br /> <br />I <br />I, <br />II <br />j! <br />II <br /> <br />Iii <br />I! <br />II <br />I ! <br />I II <br /> <br />! ~ ! <br />I <br />I <br />I <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 /> <br />C}-"t1N up /(JH) 9ro..J.l"'j c!,'rf. ror fahl SS'{) ~ <br /> <br />6. (Complete one of the following) <br /> <br />5 J' 0 o~ <br /> <br />~ The amount unpaid, whether due or not, to the claimant for the services or materials is $ <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 />~ The time the last services or materials were furnished was <br /> <br />7-/"j-()7 <br /> <br />S,5'eJ <br /> <br />~ The time the last services or materials were furnished has not yet occurred but is estimated to occur <br /> <br />------J)L-.- <br /> <br />Signature of elai <br /> <br /> <br />Subscribed and sworn to before me this <br /> <br />dJ):d;::,~ <br /> <br />Notary Public <br /> <br />/ fit, <br /> <br />S z. ", +-- k. cJ <br /> <br />,.~)o7 <br /> <br />GENERAl. NOT AnY . Stale of NebralIka <br />A. D. POWERS <br />My Comm. Exp. Nolf. te, 2D1G <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 />, <br />I' <br />~ ; <br />Ii <br />i i <br />---<-----..-- -~..-"..-~------~::::::::::.:::::.-.-----==-~:::::-:..:-:::::.====:-- ::::tt::.:-~ <br />i I <br />Rev. 9/95 : I <br /> <br />-~---ll <br />II <br />