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<br /> ONSTRUCTION LIEN Jacob North Printing Co., Inc., Lincoln, NE 68524 <br /> <br /> <br /> M 00 <br /> • In <br /> 0 4= <br /> C ~ M VA % CD <br /> cz: <br /> fV rA P17~ r~ CD <br /> 0) j0 <br /> CA __T] r~ t <br /> r'Ti <br /> QO C <br /> I = rr C J d <br /> rn ryi <br /> rrti , F_ cn F <br /> 3- CD <br /> „13 ~ • v> N y ~ fV <br /> co C/1) (DO <br /> CONSTRUCTION LIEN cn 0 <br /> 200910268 <br /> 1. The real estate subject to this lien is: L ? D-Alp <br /> 2. The person against whose interest in the real estate the lien is claimed is: a <br /> 3. The name and address of the claimant is: c L~ <br /> <br /> <br /> 4. The name and address of the person with whom the claimant contracted is: 3 <br /> a, ~ r ~ :q •y <br /> <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 rice is: ? s <~; <br /> <br /> <br /> <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 $ 1 C_ <br /> <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 /> <br /> The time the last services or materials were furnished was " <br /> The time the last services or materials were furnished has not yet occurred but is estimated to occur <br /> <br /> <br /> <br /> <br /> <br /> igna ur f alma t <br /> <br /> 5~- <br /> i Subscribed and sworn to before niG this day of I~t <br /> . <br /> ;GE:NERA:LN(0TARY - State of Nebraska HEILA R. HULME Notary Public mm. Exp. Nov, 1, 2011 <br /> <br /> (52-147. See 52-148 for amendment; 52-149 for assignment; 52-137 for recording time; 52-154 for discharge or release). <br /> <br /> <br /> <br /> 9 <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> Rev. 9/9 <br />