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<br />~STRUCTION LIEN <br /> <br />L_U <br /> <br />I II <br /> <br />Jacob North Printing Co., Inc'L~!n~~n, N~J~L_ L_f I-n <br /> <br />~~~ <br />~~~ <br />:<. ~l f_'" <br />t:> V} <br />1:-4 ~ ~ <br />~~~ <br />~ ~ n) <br />& ~ -R <br />~~ <br />~~ !lJ <br />~. ~ <br />~ ~' <br />~ ~ <br /> <br />1. The real estate subject to this lien is: ~d. \ A n;~pCl '-'tl-L Avt.._ eL) La.}. \0 )\316J: Y ) <br /> <br />~\e Roush ;:ld J'-A'n d ~ \J ;<ib;[)r"\ 4-0 c>"\ o~ c;'t I B'A Ll <:.D.) ~,}~~('(,'S.\u\ I <br /> <br />2. The person against whose interest in the real estate the lien is claimed is: c...... \ 'f'\ AJ IlL Ct. v'-.c\) <br />\ l <br />\ rJ..Vo/'d ~1'~6. \ ~O'" <br />\ <br />3. The name and address of the claimant is: ('(\; ~S ~Q c..k ho-<.. -l. 5 e"-.Jev S C2.""v ~ C R '. <br />\'y~\J "..1'9 fY\" k: \PIJ , 1?> ~~ \)), Abb()~+ ~(9 c."t.. t\.1L &)/803 <br />\ ) <br />4. The name and address of the person with whom the claimant contracted is: C i 1'\ <14, Add I Son. <br /> <br />I\.) <br />IS <br />S <br />co <br />IS <br />CJ'1 <br />.j::::. <br />co <br />co <br /> <br />~ <br />m <br />-n <br />c: <br />n Z <br />~E~ <br />~:J: <br /> <br />nO <br />%> <br />tn en <br />O:C <br />?Ii: <br /> <br /> <br />~ <br />~ <br /> <br /> r-...:> <br /> c~ 0 UJ <br /> .<..:> <br /> ....... or:::> c:> -i c:::> <br />~r c- c: J> <br />2:- ~ N <br />c:= -i rri <br />no .\-- Z c:> <br />...,--- -< 0 <br />0''': . N 0 " 0 <br />""'1", O"'J ...,., :z <br />t:':> r ::r: 1"11 co <br />m ::0 :t>- Ul c:> <br />m ::3 r ;:0 <br />0 r :l> c.n <br />en en <br /> co ;;-:: --C <br /> l:>- ex:> <br /> --C _.......... <br /> W en co <br /> en <br /> <br />200805488 <br /> <br />CONSTRUCTION UEN <br /> <br /> <br />d-,:l \ A-rCAOCthOL Q IJ~ . <br /> <br />c~ T. ~~___ <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. i\ ")-to...\\<~ {'\ ~\..I..') \!..J~ a ~Al ~~-V' \ ~ ~ Q\- ;J;;l \ ..J1yq~~Be- <br /> <br />-A 11<... <br /> <br />6. (Complete one of the following) <br />V I ',QS-I _ ," 8 <br />-A-- The amount unpaid, whether due or not, to the claimant for the services or materials is $ ~_Q \0_ <br /> <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) <br />1 The time the last services or materials were furnished was <br /> <br />3 - .J L\ - O~ <br /> <br />- The time the last services or materials were furnished has not yet occurred but is estimated to occur <br /> <br />~1v\ &~."1 <br /> <br />Signature of Claimant .. c:..~ \.., <br />O~ fY'\\14..-S &,c.~~-e. ..... ~ ~V'~ CJL <br /> <br />Subscribed and sworn to before me this :l.t;, C1!. day of 9..~4 ~ L j ,~ <br />GENERAL NOTARY - Stale 01 Nebraska /"Vf? A . /Z . / =' ______ . J .. .., .:. <br />DENICE R. KRUSE ~ ~ <br />My Comm. Exp. Sept. 25. 2010 Notary Public <br /> <br /> <br />(52-147. See 52-148 for amendment; 52-149 for assignment; 52-137 forrecording time; 52-154 for discharge or release). <br /> <br />i i -1:-- <br /> <br />Rev. 9/9t n- <br />