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<br /> <br />DNSTRUCTIQN LIEN Jacob North Printing Co., Inc., Lincoln, NE 68524 <br />T <br />~~ ~ ~ ~ <br />~ ~ f~ <br />n~~ <br />~ V A A ~' <br />~~ <br />~ e ~ ~ 1~T1 ~ N _~„ ~ ~ ~ (V C1'! <br />~ <br />~ _ <br />~ ~ ~ d <br />~ <br />~ ~ 4 <br />~ ~ ~ ~ 'rt W ~'I ~ <br />~~ ~ ~ ~' ~ ~ ~ rs7 <br />r <br />r <br />r w-p A Ci7 Q <br /> <br />~ F-' ~ W <br />w 2oo9os395 .: <br />CONSTRUCTION LIEN <br />~ ,~ <br />1. The real estate subject to this lien is:T1Lp __W~~t One Half (W~ )_ o£ _Lot Ei_g_h~(8 a an a1 1 <br />Lo v ' <br /> Wood River, Half Ca~i~it~, NE~r~sk <br />2. The person against whose interes m ere es ate `lie lien is claimed is: Ga i 1 K 1 i ng s ~o rn <br /> 3. The name and address of the claimant is: <br /> __ ___ __ Wood Riyer,Nehraska 68883 <br /> ~ .~. <br />4. The name and address of the person with whom the claimant contracted is: Ga i 1 K 1 i n s horn <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: ~~~~ 1 esl_~ tee 1 Si d i n~ _,._ <br /> com late Soffit & Fascia and Com late Seamless Steel Gutter s stern. <br /> <br /> 6. (Complete one of the following) <br /> ~_ The amount unpaid, whether due or not, to the claimant for the services or materials is $ 5_ ~ 1~ 9 - 0 0 <br /> The unpaid amount is not fixed by the contract, but a good faith estimate in the anriourit of $ <br /> 7. (Complete one of the following) <br /> ..~-The time the last services or materials were fuxxiished was .7f ~~ P 17th 2 0 0 7 . <br /> The time the last services or materials were furnished has not yet occurred but is estimated to occur <br /> ,,,, . ~.r,ss~., P~s,,~~` <br /> ~~~w~~~ <br /> <br /> Signature of Claimant <br /> Subscribed and sworn to before me this ~~ `~ day of , ~~ ~ <br /> <br /> GINERAt. NOTARY -State of Nebraska Not Public <br />I]t~NIC~ Fi. ICFiIJSI~ ~' <br /> fJly Comm. Exp: Seg. 25, 2010 <br /> (52-147. See 52-14$ for amendment; 52-149 for assignment; 52-137 for recording time; 52-154 for discharge or release). <br /> _....----... .. ......_ ............ -.T -~ ~ <br /> Rev.9/9~ <br />...__ <br />N <br />m <br />rn <br />W <br />CTI <br />