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22,3 CONSTRUCTION LIEN <br />Jacob North Printing Co., Inc., Lincoln, NE 68524 <br />�} <br />m <br />r.� <br />�• <br />f'fi <br />„': <br />cry <br />O -i <br />pj <br />z <br />nn <br />r <br />> <br />FTI 'j' <br />r" ' <br />0 <br />M <br />O <br />O <br />CD <br />T3 <br />co <br />Q <br />N <br />m <br />r co <br />�< <br />N h, <br />N <br />O <br />U, <br />1� <br />200501014 <br />Cn <br />CONTRACTING OWNER OR SUCCESSOR IN <br />INTEREST: <br />11` ?� <br />(Name) -P <br />--- ..... - - -- - -..., �&d------------------------- <br />� .6- � --------- - - - - -- <br />CLAIMANT: <br />(Name) <br />- - - -- ...... �-_ i�!^.t� ------------------------------------- <br />(Address )� c <:- <br />------------------------ -- �.: <br />9z--- �u-=------------------------------- - - - - -- <br />(Phone) <br />REAL ESTATE: <br />(Leg q] <br />escr3,ion) •1 <br />n..- _kUUUr :- I:2u,,.&er.... - w ! !i' <br />0.6.o ►1 -- eat -C <br />oy? <br />' t 5!. <br />CLAIMANT CONTRACTED WITH: <br />(Nam - <br />0 n,:--z-,- 6�6L <br />-- -------------z.--- <br />----------- - - - - -- - -- <br />(Address <br />------------------ )Gr- te- - <br />- ---- 80 1------ - - - - -- <br />- - - -- -.air ::"K -mot- r7L >'3-- - - - - -- --------------------------- <br />(Phone) <br />SERVICES OR MATERIALS FURNISHED BY CLAIMANT: rn .00272 <br />y------------------------------------ <br />e.k. , -n .� . ` � `.j nc cell _► c�,� l -- :�- -r ..�n_�`>.. C� ..hCmtc------------------- ------ - ----------------------------- - - - - -- <br />CONTRACT PRICE: ----------------------- ... <br />AMOUNT UNPAID: $ ... " -`�OOQ: Q �! -------- ------ - - - - -- - -- - <br />12. � <br />TIME LAST SERVICES OR MATERIALS FURNISHED: ----- - - - - -- �� -- - - - - -- -------------------- - - - - -- *-------------------------------------------------- <br />Stateof ------------------------------- --------------- - - - - -- <br />SS. . . . .. ... . . . . .. .. ........ .. . . . .. .. ..... .... ............................... . . . . .. <br />-- - - - - -- --- - - - - -- County Signature o Claimant <br />010 0� <br />On this day of before m otary Pu is in and for <br />said county, personally came --- ----- -- --- ---- --- - - -- - - - - -- ---- - .- .- .-------- ..- . - - - -- ----------------- .. to me known to be the identical person or <br />persons who executed the foregoing instrument, and acknowledged the same to be his, her, or their voluntary act and <br />deed. GENERAL NOTARY - State of NebraSla <br />DENICE R. KRUSE s. s , <br />My Comm. Exp. Sept 25,2M8 .. <br />otary Public. <br />My commission expires the ��" day of_.. -- -- , .. <br />STATEOF ---------- --- -------------------------------- - - - - -- -------- - - - - -- <br />ss Entered on numerical index and filed for record <br />County of - --- ------------------------------------------ ------------------- ... in the Register of Deeds Office of said County the <br />----- - ----- - - - -- --- day of--------------------------- - - - - -- - - - - -, ------ ...... , at------------------------------- - - - - -- o'clock and---- - - - - -- ............. minutes .......... ....... M., <br />and recorded in Book k. -- ... ...... - - - -of - ------------ ----------- - - - -at page------ - - - - -- .................. <br />................ ------------------------------------- - - - - -- -Reg. of Deeds <br />BY--------------------------- - - - - -- ............................. -------------- - - - - -- Deputy <br />Rev. 8/95 <br />