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<br />.... V\ ~ <br />f~ ~ Q:, <br />~() ~ ~ <br />7' .:Jd lA ~ <br />c.2 /_ <br />~ '\ 1}J}{' <br />ll\ ~ ~ --, <br />u"l::I..- <br />r ~' i'b <br />~~"'\ <br />~D~ <br />~ ~.;!. ~ <br />I (' \:7.l <br />'" - <br />\~ <br />~ <br />1 CERTIFICATE OF CLERK OF DISTRICT COURT OF HALL COUNTY <br /> <br />N <br />IS <br />IS <br />co <br />IS <br />c.n <br />CD <br />...... <br />c.n <br /> <br /> <br />;lIa <br />.~ <br />c: <br />z <br />Ono <br />~)OO~ <br />nr"" <br />~::l: <br /> <br /> <br />~s <br />o:z: <br />~ <br /> <br />1. The real estate subject to this certificate is: <br /> <br />Legal Description: <br /> <br />''1 { <br />~ "~:: <br /> <br />,., ~:.',~ <br />", <br />o <br />'1 <br /> <br />.'~ <br />=.:. <br /><=> <br />co <br /> <br />(") (j') <br />o -, <br />c: J> <br />z-i <br />--ffTl <br />-<0 <br />0"'" <br />l'1 :;;.~ <br /> <br />:r rl1 <br />p. 0:'1 <br />, ;0 <br />,p. <br />(f) <br />;:>0;: <br />1> <br /> <br />............... <br /> <br />(f) <br />(f) <br /> <br />Lot One (1), Saint Francis Medical Third Subdivision, Grand Island, Hall County, <br />Nebraska <br /> <br />C- <br />c.-::: <br />r- <br /> <br /><:.0 <br /> <br />o d- <br /> <br />~ r <br /> <br />r'0 <br />-..J <br /> <br />-0 <br />::3 <br /> <br />~ <br /> <br />Property Address: <br />2620 West Faidley Avenue, Grand Island, Hall County, Nebraska <br /> <br />2. The entity against whose interest in the real estate the <br />lien is claimed is: <br /> <br />Saint Francis Medical Center <br />2620 West Faidley Avenue <br />Grand Island, NE 68803 <br /> <br />3. The name and address of the claimant is: <br /> <br />Anderson Flooring, Inc. <br />3410 S. 81"' St. <br />Lincoln, NE 68506 <br /> <br />4. The instrument number is: <br /> <br />0200708332 <br /> <br />5. The amount ofthe claim is: <br /> <br />$10,586.43 <br /> <br />6. A general description of the claimant's services performed or to be performed or materials <br />furnished or to be furnished for the improvement and the contract price is: <br /> <br />Carpet and base installation. <br />7. The name and address of the entity making the deposit is: <br /> <br />Commercial Flooring Systems, Inc. <br />11008 John Galt Blvd. <br />Omaha, NE 68137 <br /> <br />o <br />N, <br />O. <br />0; <br />co <br />o <br />Ul <br />en <br />t-" <br />en <br /> <br />m <br />~ <br />:0 <br />m <br />c <br />~ <br />Z <br />~ <br />:0 <br />c: <br />s:: <br />~ <br />e <br /> <br />/0, .s-D <br />