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<br />I'\J <br />\'5) <br />\'5) <br />c..n <br />\'5) <br />c:.o <br />m <br />I'\J <br />I'\J <br /> <br /> <br />"'INSTRUCTION LIEN <br /> <br />Jacob North Printing Co., Inc., Lincoln, NE 68524 <br /> <br />~ <br />~ <br />~ <br />f'\) <br />SJ <br />1'. <br />So:::: <br />~ <br />~ <br />~ <br />~ <br /> <br />~~ <br />OX <br />7'; <br /> <br /> 1'..."'..... <br /> ("':::;'''> C"il <br /> c;:.,'"Io ( " <br /> " <br /> :~::,:t "-" <::') -..4 <br /> (I} c: :t.... <br />::ti (, " r-rl % --J <br /> f"~ -"j rr'1 <br />:-T: (>. --0 <br />Iw';':' ~ ,. "....... -< l~~ <br /> ...r'.... N <br />"" \~ 0 '1 <br />."f'1. -...J ""'-1 <br /> , . <br />~ l "I <br /> .. <br />" ;:~ \:J )>. r,:' '~'.'J <br />rn , ::3 r-- ~tJ <br />Co-) l: r :;:>- <br />(<) (i) <br /> t'- .....::: ^ <br /> p. <br /> N ---- --- <br /> ....I:: W <br /> (f) <br /> <br />10 <br />m <br />""" <br />c <br />() Z <br />~~~ <br />n(l) <br />~:x: <br /> <br /> <br />CONSTRUCTION LIEN <br /> <br />200509622 <br /> <br /> <br />1. The real estate subject to this lien is: <br />Lue:~~ ~J d (0(H-~ ~.( lcTl... s,CJ-l-. L ~ <br /> <br />! 2. The person against whose interest in the real estate the lien is claimed is: -f\\QlSO.' ~ ~,C'.....c;..t:.-'("' <br /> <br /> <br />3. The name and address of the claimant is: t,\ \.r-\- 'f'.p ~.~ \("" tJ~~ \=-e x"" \r-1l"" 9 \ ~ ~cc.j <br />\c.-.)\.\. c;,'l1-t:t&. ('l~~\~,....._ [\<(' _ l",~X'J-1 <br />4. The name and address ofthe person with whom the claimant contracted is: _{\.\lsn It"- <;\...c..J.:c- 'c- <br />.' 05 Q-.:dL.....,.e-.~r~ G("~s::.,%".....-).., li~ bV6C:,,:] <br />. C \DeS--' . _ . ' "0 <br /> <br /> <br />5. A ge?eral descrip?on of the claimant's services Pa:t'o~ed ~ to be performed or materials ~rnished or to be <br />furrushed for the Improvement and the contract pnce IS: ~!ij;trJ' \ c:"'r-t t>:>'....- I.' '" t' .f:..---.^-- <br /> <br />~ \I'ro.aJ; '" -\-o.-Q t-c. ~l':\~ <e... '* {cl"5 't \r.. J..- Co., c.\.o!. c;..: U e. <br /> <br />6. (Complete one of the following) <br />~ The amount unpaid, whether due or not, to the claimant for the services or materials is $ d~1 ~ I rvJ . <br />~ The unpaid amount is not fixed by the contract, but a good faith estimate in the amount of $ ~15, exJ <br />7. (Complete one of the following) <br />~ The time the last services or materials were furnished was 5,- 'd"l ~ {')s <br /> <br />~ The time the last services or materials were furnished has not yet occurred but is estimated to occur <br /> <br />~~ <br /> <br />i~tur~otCIair.n;mt D. () h Fe)/\$.. 4r 0 <br />r..: u.,...-r teptSfer- D fit (,LV"b J tlfJ <br /> <br />~ 7z:L day of <i?e;4 ~ ~ <br />~R,~ <br />Notary Public <br /> <br />Subscribed and sworn to before me this <br /> <br />GENERAL NOTARY. State of Nebraska <br />DENICE R. KRUSE <br />My Comm. Exp. Sept. 25, 2006 <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 />Rev, 9/9 <br />