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- CONSTRUCTION LIEN <br />r� <br />�y <br />Jacob North Printing Co., Inc., Lincoln, NE 68524 <br />CONSTRUCTION LIEN 200501013 <br />1. The real estate subject to this lien is ? ,= .�1. <br />Aq,c( Z. 11 hn 101 1 i6CN,c_.. f , IL OCa <br />2. The person against whose interest in the real estate the lien is claimed is: 11s� �Lt <br />3. The name and address of the claimant is: L� * N001- <br />O <br />I-+ <br />W <br />IL <br />4. The name and address of the person with whom the claimant contracted is: Z263 ` t Ul l e -r_r° <br />5. A general description of the claimant's services perform to, t be performed or materials furnished or to be <br />furnished for the improvement and the contract price is: R� `P I i� ` c�� t f K <br />�j ftEJ ^V6� ��� 11' eA(A l'11��f ��(5�: G + �i�%�4 S f�1�llil bL Y'e.c..,cn 11 �J��l�l { n1i <br />a <br />6. (Complete one of the following) <br />The amount unpaid, whether due or not, to the claimant for the services or materials is $ <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) 77++ <br />The time the last services or materials were furnished was <br />!"1/U <br />The time the last services or materials were furnished has not yet occurred but is estimated to occur <br />Subscribed and sworn to before me this <br />GENERAL NOTARY - State of Nebraska <br />DENICE R. KRUSE <br />My Comm. Exp. Sept. 25, 2006 <br />--5r1n1-6 <br />Signature of Claimant <br />day oA v��b <br />o <br />Notary Public <br />(52 -147. See 52 -148 for amendment; 52 -149 for assignment; 52 -137 for recording time; 52 -154 for discharge or release). <br />Rev. 9/99 <br />Phi <br />C/7 <br />o n <br />r : <br />...._ <br />-n �. <br />_ 0-1 <br />m <br />•T'' <br />o <br />r— �- <br />V> <br />N <br />C n <br />(!a <br />C!) <br />CONSTRUCTION LIEN 200501013 <br />1. The real estate subject to this lien is ? ,= .�1. <br />Aq,c( Z. 11 hn 101 1 i6CN,c_.. f , IL OCa <br />2. The person against whose interest in the real estate the lien is claimed is: 11s� �Lt <br />3. The name and address of the claimant is: L� * N001- <br />O <br />I-+ <br />W <br />IL <br />4. The name and address of the person with whom the claimant contracted is: Z263 ` t Ul l e -r_r° <br />5. A general description of the claimant's services perform to, t be performed or materials furnished or to be <br />furnished for the improvement and the contract price is: R� `P I i� ` c�� t f K <br />�j ftEJ ^V6� ��� 11' eA(A l'11��f ��(5�: G + �i�%�4 S f�1�llil bL Y'e.c..,cn 11 �J��l�l { n1i <br />a <br />6. (Complete one of the following) <br />The amount unpaid, whether due or not, to the claimant for the services or materials is $ <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) 77++ <br />The time the last services or materials were furnished was <br />!"1/U <br />The time the last services or materials were furnished has not yet occurred but is estimated to occur <br />Subscribed and sworn to before me this <br />GENERAL NOTARY - State of Nebraska <br />DENICE R. KRUSE <br />My Comm. Exp. Sept. 25, 2006 <br />--5r1n1-6 <br />Signature of Claimant <br />day oA v��b <br />o <br />Notary Public <br />(52 -147. See 52 -148 for amendment; 52 -149 for assignment; 52 -137 for recording time; 52 -154 for discharge or release). <br />Rev. 9/99 <br />