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<br />II I <br /> <br />___...l.....L I <br /> <br />!! l1_45 - CONSTR~CTION LIEN <br /> <br />Jacob North Printing Co., Inc., Lincoln, NE 68524 <br /> <br />0~_~ <br />~~c:-g <br />~fi\' <br />- ~ ;;)- <br />LJ l.-, "'. <br />~ -t N <br />0r--,X <br />~ PJ.'~' <br />>'-.\') <br />?:.. ~. r'~ <br />~ r. a <br />, , - :5 <br />':+ <br />') <br />r::::: <br />~ <br /> <br /> e no <br /> ::Z:)I- <br /> c: ~cn <br />n Z ;;l'i\::t <br />% ~~ <br />~ ~ C) <br />" <br /> \) <br /> tr <br /> <br /> I~ <br /> C'-> o .(fJ <br /> <=> <br /> ~'l.. c:;E;> O~ <br /> c:~ <br /> :z: :z~ <br />~~' = ~.1'Tl <br />rr\ ~ c:::: -<0 <br />0., - N 0" <br />0 0 "Z <br />., <br />t::I r ::I: fT1 <br />m \J > co <br />m ::3 r:::tl <br />0 ,)> <br />(J) (j'l <br /> t-" ;:>0;: <br /> )> <br /> c.n -- <br /> c.n en <br /> en <br />200809595 <br /> <br />I\..) <br />S <br />S <br /><Xl <br />S <br /><D <br />Ul <br /><D <br />Ul <br /> <br />C'-. <br /><->c. <br />~--' <br />Q <br /> <br />CONSTRUCTION LJEN <br /> <br />t,oo <br /> <br />';> <br /> <br />'&11 WEST C/-lA.RLE5 - GrWND ISLAND I Nt... <br /> <br />1. The real estate subject to this lien is: <br />CI~ARL€S-kJA'S(Y1ER.. ADDll/OrJ - E ;;Z(,,' LOT -3 ANO <br /> <br />I.U -3 q. l.{., , LO T ,2.. <br /> <br />f3 Lk. 31.....- <br /> <br />2. The person against whose interest in the real estate the lien is claimed is: <br />DO LF e, I Ct-fTE R.TZ. I lYlD <br /> <br />3. The name and address of the claimant is: f2D(-,Ef\... kRZ'/Ckl COtJSrRUCTIOf-.J, lNG- <br />8D~ 'i.l\<;T (()"fPJlTAL - GR./\IJD lSU\I-.ID I ME.. &€.''601 <br /> <br />4. The name and address of the person with whom the claimant contracted is: <br />DOLF- (<.. ICI.(TE'Ru. , lY1D I SD~ WeS-, CHfHZ.LfS ) L~R.{l.Nb ISLA"JD I ~ E <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 />NEW GARflGE~- 1Jt:1U fYlASONMI( FfJ.lCt - Co~CR.EIT, DRIVEiLJA'lS AJ..jD lU4U<.S-. <br /> <br />I nTFg.lo/C AND (ltTFR..IOR.. /~O()S~: k:.Ety)DOU__ - pLUMBING AN(.) ElfCTRl CAL WDK-IL <br />BiLUNG 8A9,Fl) OiIJ k)OR.K (OMP L.HfD AS JDB PRDGI2-C:'Sf'O. <br />6. (Complete one of the following) <br /> <br />I :13,20/.30 <br />_ The amount unpaid, whether due or not, to the claimant for the services or materials is $ _ <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 />~ The time the last services or materials were furnished was <br /> <br />OCTOBE,t, :21, .;l.OOg <br /> <br />_ The time the last services or materials were furnished has not yet occurred but is estimated to occur <br /> <br /> <br />Subscribed and sworn to before me this <br /> <br />IJffl <br />"",00- day of NOVEmBER-- <br /> <br />P atu tUv 1- )L.fn.L/1.~ <br />N otazy Public U <br /> <br />i<..Dog <br /> <br /> <br />GENERAl NOTARY. state or Nebraska <br />PATRICIA J. NOWAK <br />My Comlll. Exp. May 21, 2009 <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 />iil'. <br /> <br />I II <br /> <br />I II <br /> <br />I II <br /> <br /> <br />Rev. 9/~J i i <br />