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I 145 - CONSTRUCTION LIEN Jacob North Printing Co., Inc., Lincoln, NE 68524 ni �� O v CD CD o C W �_ Cf1 rte, T-r c:a O � � O U) CAD \ v O cAi S Co W ( Cn CONSTRUCTION LIEN 200500363 i 1. The real estate subject to this lien is: Lot 12 Block 6 Bel Air Addition, City of Grand i Island, Hall County, Nebraska; known as 1615 Sonrh Arthur Street 2. The person against whose interest in the real estate the lien is claimed is: Sonya Jones 3. The name and address of the claimant is: Tom Soukup 1728 Bridle Lane, Grand Island, Nebraska 68803 4. The name and address of the person with whom the claimant contracted is: Sonya Jones, 1615 South Arthur, Grand Island, Nebraska 68801 5. A general description of the claimant's services performed to, to be performed or materials furnished or to be furnished for the improvement and the contract price is: Install new furnace and air conditioner for n total price of $2.700.00 r M i i 6. (Complete one of the following) .Xx _ The amount unpaid, whether due or not, to the claimant for the services or materials is $ 1.175-00 The unpaid amount is not fixed by the contract, but a good faith estimate in the amount of $ f 7. (Complete one of the following) XX The time the last services or materials were furnished was October 10, 2004 The time the last services or materials were furnished has not yet occurred but is estimated to occur r i Slignat of Claimant ��sar 'el LZ 14 i Subscribed and sworn to before me this �J day of GENERAL NOTARY - State of Nebraska STACEY A RUZICKA Notary Public My Comm. Exp. May 10, 2007 i I j (52 -147. See 52 -148 for amendment; 52 -149 for assignment; 52 -137 for recording time; 52 -154 for discharge or release). i I I I I i w J E i I i j 1 Rev. 9/9