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<br />I II <br /> <br />___ .._..~.~,.~r:;;:.~LL~~~~ <br /> <br />~~~O~~___~_~___~________~~~~~~U~~~~~. ~ <br /> <br />~~~~ !ii 2 ~ ~ I' <br />~t ~ ~ 2 n ~ ~ :J: ::,,; ~ ~ <br />~flf [ ~ ~ ~ ~~;: i ~ <br />r~'~ ~ ~~ ~ ~ ~ <br />~' ~t~ ~ to?; <br />~ \ ~ \ C'..L ........_ <br />~ I: ~ (...) (() <br />~ ' ~ 200709490Ul <br />~ ,) CONSTRUCTION IlEN <br />~) <br />......... <br /> <br />< i <br />j' <br />i I <br />I' <br />1. The real estate subject to this lien is: /C'- W /,-!'2J <; f. 6ro 11 J 1 , Lcou/ ; lVi..':- 6 'frr-cJ I I II <br /> <br />1,,-1 I /~ "b"k ~.,vod.y ./;'" r. 11'1 WJ.e~/"f ,q-eJ1nell~ 1J.,rd t!"d~I/';~ h "r&N.J...l~~ <br /> <br />2. The person against whose interest in the :eal estate the lien is claimed is: --r; n 11 'I" /' j'J'k L y' I i I <br />I I I' <br />; I <br />'I <br />It~?I9I1I'\ '1',61 II <br />I : i <br />I ! i <br />I: <br /> <br />I I! <br />II <br />II <br />! I <br />II <br />I' <br />II <br />II <br />! ! <br />i i <br />: I <br />I j <br />! I <br />i I <br />I; <br />II <br />! ! <br />~ ; <br />Ii <br />i i <br />I. <br />i I <br />i! <br /> <br />( ~ <br />I i I <br />I <br />I! <br />II <br />I' <br />II <br />i I <br />i i <br />I i I <br />I II <br />day of Y/ov ,.~a27 I !! <br />Nfttl~tt~ it L-~-1 ! I <br />! <br /> <br />N <br />is <br />S <br />-..J <br />is <br /><0 <br />.f::>.. <br /><0 <br />is <br /> <br /><!/JI/? 7 <br />3. The name and address of the claimant is: I3LIA i? tlo" I::L~e t.?l en (! I .../Clm>tJ~ <br />/ If fk; /Y. flu ~;'/1 /l V If" t:! r.;, ,,) .I sLp J" / IV~:? r-i-P' ~ <br /> <br />4. The name and address of the person with whom the claimant contracted is: <br /> <br />/tJ:F tAl /,-tl'S I, tf'rdn/r5Lo1J4~ /!/IF~fftf 3 <br /> <br />1t7/1J1fJr /f1RLv <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 /> <br />Sfc;rm daW1d~P I(v.'tJa./'" Or' fJ,-c ("Yfr'I/p, /Jdrfl;"/1 c( rJ.-e. <br />{/ I V <br />I'tf't1I1,mn {lJl!'elY/&"lL S'1"rv/c"lt" <br />, <br />6. (Complete one of the following) <br /> <br />---.IL. The amount unpaid, whether due or not, to the claimant for the services or materials is $ <br /> <br />j 9t'. ~ <br />. . <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 />tJfr' pr dr#tO'l/ J t1 t'!t" II, ;).tYC! 7 <br />, . <br /> <br />- The time the last services or materials were furnished has not yet occurred but is estimated to occur <br /> <br />I <br />II <br />[ i <br /> <br /> <br />r7Lilie fA, /1 <br /> <br />/ <br />V <br /> <br />Subscribed and sworn to before me this <br /> <br />J;GENERAL NOTARY.Slale of Nebraska <br />III CYNTHIA J.~!.ERN r; , / / <br />.. My Comm. Exp. -?II <br /> <br />I (52-147. See 52-148 for amendment; 52-149 for assignment; 52-137 for recording time; 52-154 for discharge or release). <br />I <br /> <br />i i <br /> <br /> <br />Rev. 9/9 <br /> <br />i <br />. i <br />i: <br />I; <br />.1 <br /> <br />:~~ <br />