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<br />N <br />S <br />S <br />""..J <br />S <br />co <br />W <br />W <br />N <br /> <br />r~~ <br />t~f <br />'( ~'[' <br />~~t <br />~ '. <br />~~ ' <br />~ ~; <br /> <br />~ J~ <br /> <br /> ;;0 (') C) <br /> r'~1 :c )> <br /> -1"11 l'n Ul <br /> (M' n ::J; <br />t"'.I :t:l.~ " <br />1': n \:.:1 <br />rl'1 )> (li , <br />(1 If.rl <br />7\: ::c <br /> <br />~, <br />~. $~' <br /> <br />o"~ <br />""'r] <br /> <br />~ f:.~;' <br />~ ~ <br /> <br /> <br />CONSTRUCTION LIEN <br /> <br />"" <br /><=.:> 0(1) <br />c::::> <br />-.:J <:) ~ <br />(n Q. '.)l>. <br />:z -,..! <br />rr1 -i rT1 <br />-0 <br /> -< 0 <br />N C "TJ <br />CD -., ~~ <br /> :r rTl <br />::0 l> 0:;1 <br />::3 , :xl <br />, l> <br />,....... UJ <br />I--" ;><; <br /> :t> <br />......... ~'.",-----" <br />C) (J) <br /> en <br /> <br />1. The real estate subject to this Hen is commonly known as 2620 West <br />Faidley Avenue, Grand Island, Nebraska and is legally described as follows: <br /> <br />Lot One (1), Saint Francis Medical3rd subdivision, Grand <br />Island, Hall County, Nebraska. <br /> <br />2. The party against whose interest in the real estate the lien is claimed <br />is: Saint Francis Medical Center. <br /> <br />3. The name and address of the claimant is: Andersen Flooring, Inc., 3410 <br />South 81s1 Street, Lincoln, Nebraska 68506. <br /> <br />4. The name and address of the person with whom the claimant <br />contracted is: Commercial Flooring Systems, Inc. <br /> <br />5. A general description of the claimant's services performed and material <br />furnished for the improvement and the contract price is: tLUpRt- und 6; .s:e... <br />r'1S+c, II,;-I.'c~n ,withacontractpriceof$ Ie), ,'18(0.,,/3- <br />.. , <br /> <br />6. The amount unpaid to the claimant for the services and materials is: <br />$ iO I I")-e,lu~ <br />. <br /> <br />7. The time the last services or material were furnished by claimant was: <br />A ~ Q 5+- tZL., 2007. <br /> <br />ANDERSEN FLOORING, INC. <br /> <br />.~D,"jJ~ <br /> <br />Scott D. Andersen, President <br /> <br />STATE OF NEBRASKA ) <br />) ss. <br />COUNTY OF LANCASTER ) <br /> <br />The foregoing instrument was acknowledged before me this~ day of <br />September, 2007, by Scott D. Andersen, the President of Andersen Flooring, Inc., <br />on behalf of said corporation. <br /> <br />i1NJ/J4) tf1 V1!MdI <br />N ta:!y Public <br /> <br />~ GENERAL NOTARY. State of Nebraska <br />III SUSAN M. MUNDT <br />My Comm. Exp. A\lIII22, 2008 <br /> <br />1.0764284.1 <br /> <br />C) <br />N <br /><::) <br />C) <br />-...J <br />C) <br />CD <br />W <br />W <br />J'"'.) <br /> <br />~ <br />a <br /> <br />:> <br />if) <br />",- <br />V:J <br />~} <br />~ <br />... <br />:2 <br />o <br /> <br />_. <br />c:> <br />~ <br />