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<br />-64--
<br />Jacob North Printing Co.,lnc.JJ!!colnLNE ~~524_J__ll_
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<br />ISTRUCTION LIEN
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<br />CONSTRUCTION UEN
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<br />1. The real estate subject to this lien is: :J 'I;l, 7 /L--. J:6 r k C; YO ncl J: 5 &"j . /11 F
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<br />2. The person against whose interest in the real estate the lien is claimed is: A y 10 /V Va A L ~
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<br />3. The name and address of the claimant is: i3LY. 't? tJtfl n1'-FI- .n~/nc. ~ Inn tti ~ //o/;,J4/1n rJ r"~,
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<br />4. The name and address of the person with whom the claimant contracted is:
<br />c1tJc;? (IE) 1k/1 t<.A?:rd Rd____ 6rCtn/ Is Lt:7n/ N {=
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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:
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<br />1"[Or;>>/r (1t1#t1 J//~kl;p~f 1-0 1J,t" ;J..4'J.. I ~. (Je,/I( [1. frC'.I:rr>/'lv ~ 7J~se
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<br />6. (Complete one of the following)
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<br />-L The amount unpaid, whether due or not, to the claimant for the services or materials is $ .l...ZY, 22jzv
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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)
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<br />-L'The time the last services or materials were furnished was 0 )'t/' () r a r..l7l-1 r1J J () )1 t9 /J,::J . 'J,..tJd 7
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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 />Subscribed and sworn to before me this
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<br />J;ENERAL NOTARv.Stare. 01 Nebraska
<br />III CYNTHIA J. STERN
<br />-. - My Comm. Exp. - - V /
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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 />Rev. 9/9 II
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