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~~ <br />~ NSTRUCTION LIEN <br />NCO ~~ ~4 <br />~~ N~a~ <br />~~~.~~ <br />!JI-'n~ L~~, <br />~ ~ ~~ <br />-~ <br />~~ ~- <br />--- <br />Jacob North Printing Co., tnc., Lincoln, NE 68524 <br /> <br />~ <br />~ - <br /> <br />~ ~ <br />~ ca cn <br />O ---1 <br /> ~ s <br />~ ~~ <br /> z - <br />. ~ ~ -~ <br /> <br />~ y .. ~j ca ` t1] C] <br /> <br /> c., ~ ~ rn <br /> ~ ~. ~:~ <br /> m <br />~ r ~ <br /> ~, r n <br /> ~ <br /> ~ x <br /> <br /> cn '~''-' <br /> rV Sn <br /> cn <br />CONSTRUCTION LIEN <br />2oosos~o~ <br />1. The real estate subject to this lien is: ~ ~-4-~ Opt--#- GC~- <br />2. The person against whose interest in the real estate the lien is claimed is: t--~ ~ ~ ~-~-~ ~ <br />3. The name and address of the claimant is: ~~~"'7 ~~ <br />4. The name and address of the person with whom the claimant contracted is: ~sz. h ~ 1 <br />-~ ~~ ~ ~ ~ ~ ~' _ __ ~ ~Q°~1 ~ S ~Ct (~ / 1. 1' ~n ~C7 <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 />1 <br />6. (Complete one of the following) <br />The amount unpaid, whether due or not, to the claimant for the services or materials is $ ~ ~~ • ~y <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 ~- rriU ' ~ ~• <br />The time the last services or materials were furnished has not yet occurred but is estimated to occur <br /> <br />Signature of Claimant <br />Subsribed and sworn to before me this <br />~~ ~ <br />'-~`~ day of ~ ~ . <br />' GENERAL. NaTARY -State of Nebraska /~ . ~. <br />-~--- <br />pENICE Ft. KRUSE Notary Public <br />~~ ~ _ My Gomm. Exp. Sept 25, 2010 <br />(52-147. See 52-148 for amendment; 52-149 for assignment; 52-137 for recording time; 52-154 for discharge or release). <br />Re~. 995 ~____l i <br />