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<br />\I <br />" <br /> <br />I\.) <br />cSl <br />CSl <br />co <br />cSl <br />CD <br />cSl <br />I\.) <br />(]l <br /> <br /> <br />STRUCTION llEN <br /> <br />Huffman and Felton & Wolf, Walton, Ne. 68461 <br /> <br />~~.J~ <br />~ --.J ~\ nj <br />~ ~rt '\ <br />t7 (/.) " !tl <br />~~~0 <br />~~ <br />~ ~ <br />b-';;1 <br />"' ~ <br />~~ <br />"t:7 <br />~ <br />~ <br />t':> <br />LI.J <br /> <br />10 <br />m <br />." <br />c: <br />.", ~ ~ <br />:t en <br />.-n .. <br />.') VI <br />~:J: <br /> <br />Q~ <br />m (Il <br />O:t <br />:;I'l; <br /> <br />200809025 <br /> <br />CONTRACTING OWNER OR SUCCESSOR IN <br />INTEREST: <br /> <br /> <br />-t.....____..... ..........._.................._m__..............._. --... ..... .................. <br /> <br />.~~.~.~.~~..h_..k~.J..........Q>.t_b?.~.~9Q.~.....~J..: <br />..........__........Ct..L.........l\l~........m~~.BQ.L_._.m...._._.. <br /> <br />CLAIMANT: <br /> <br />..........~rkfQ--~.~.n~-.-............,..........-.-- <br />(Name) '1130 S M()y\l'\-\>( n\. <br />:~~~:~~~~~~:&:~i::~::::~~:.::::::::0:~~~::::.:.:.:::-:----.::::::: <br />..........30.~.::.).B.k_~..~.~.~.\.........m____................_....---------. <br />(Phone) <br /> <br /> <br /> <br /> r....:> <br /> .:.:.::::..-.... 0 C/) <br /> f~ 0 <br /> '-( co 0 --1 <br /> ...-::.,. c:: :t,.. rv <br /> = :Z --1 <br /> ('"'- "- '::-::>> <br />..:0 , \ --1 fIl- a <br />,'1 (\_ ~ <br /> --< c...::) ~ <br />,,-) <{'- N 0 -"Tl 0 <br />0 -.J --;"J <br />'^1 ,..0/"_, co Z <br />C"..J tt ..- I'T1 ~ <br />rr1 Fl ~ -0 >- t).J 0 <br />III :3 I ;:a ::D <br />0 ~ I :t> CD C <br />(fJ ~ (f) 0 :5: <br /> G.) :;><: m <br /> :I:>- N ~ <br /> I--" --- --- <br /> 0 CFJ Ul Z <br /> (f) 0 <br /> <br />REAL ESTATE: <br /> <br /> <br />iL~ii~~~Pti~!~.~~J(rJ.m;:tt...I.r~b..m. <br /> <br />_............. ...................._.._\J.!~......... ...... .......~........_.._..___~_____._.... ..... <br /> <br />........~__~J___...N~....M.~'r~_______.................................. <br /> <br />:'J <br /> <br />CLAIMANT CONTRACTED WITH: <br /> <br />......W.OO.d.~~l_~...C#..SJV.M.._tWmt->._..._.................... <br />.~.~~_~)mZ)tQl.......~.nw.9_Q.J.....fJ;..,..........___------- <br />.~~~_~.~_s~~.b;L.......~e.___........teflJO..\-...-...-.-------_____...._. <br />3!J.b-:::.1Ji.::...qJQ<+-----.....................---......----------------........ <br />(Phone) <br /> <br />SERVICES OR MAT~RIALS FURNISHED BY CLAIMANT: ...........~.d-~.p~.r.\l-mm-.-.............................--m----.......... <br />....~J.tl..W.Q.O'~J~!.~(d:..-CtP.n.dr.YL+tn(\....~tk1..~S4.f2.~---~€n~v.9fCQf\..~/.tnc:,----mm...-.................-.---- <br /> <br />, <br />............................_u............._._...........__...... ........_.____........ .............n.._.__............................____.......... ... .........________._H............. <br /> ..----------------.-........ ..... .........---- <br /> <br />........._____..........._._u... ....n__._...........____..............__._........ ........ ....__._._._u..................._._._____._.... ...... ..........----.-.. .... ................--------... <br />....... ... .........-.-..------- -....... <br /> <br />~ .0 <br />CONTRACT PRICE: $.....__k~P.Q.:....._.............__..m_.._ AMOUNT UNPAID: $..........~-~~..~....................-.------ <br /> <br />TIME LAST SERVICES OR MATERIALS FURNISHED: ...._.._.mQ<:.:-tY.~(1(...]l..?Qeg.-.-mm..................m..--m--.--..................-. <br /> <br />sm~ Of~le~l-~'5..!f.~...----........-m..........I". ............~.lJiJ~~.\\r,!:lf~lur\.PN.. <br />..m..._m.__......!'1Et... ..__m..........____......County Signa ure of Claimant <br /> <br />On this '..!!.J.:J!!'..~..... day of _........Q&..O'.~......._..._..............m...__.__........,~ before me a Notary Public in and for <br /> <br />said county, personally came __;)jf.~f:!..Kmkt~JJJ$r..............-.mm--........ to me known to be the ide~tical person or <br /> <br />GENERAL NOTARY - State of Nebraska <br />KRISTI K. FRALEY <br />My Comm. Exp. March 29, 2009 <br /> <br />persons who executed the foregoing instrument, and acknowledged the same to be his, her, or their voluntary act and <br />deed. <br /> <br /> <br />m...~~??..(k~ .~....m________...........__.____ <br /> <br />;..(...'oK'-''''><:-:'-==~ary Public. <br /> <br />My commission expires the...................~__........day of..........m..............__................__..., 19m.m...... <br /> <br />STATE OF .-........-.-...........-M......--......................--........}ss. <br /> <br /> <br />County of ............._....................._.........._....................... <br /> <br />Entered on numerical index and filed for record <br />in the Register of Deeds Office of said County the <br /> <br />......__.........._.day of...._..........___......____........___., 19_..........., at............._........................o' clock and......__..........____..minutes..........____....M., <br /> <br /> <br />and recorded in Book.__.........._.........__.....of.._........................__.at page.._........m..__............. <br /> <br />'.'\i_. <br /> <br />..---...........-----........----.-..........-.........-.--.-.........-----..... <br /> <br />Reg. of Deeds <br /> <br />By .....m..._........__m.........____._........__._.........._.___..........___...... Deputy <br /> <br />Rev. 8/95 <br />