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<br />221-A-k1EGMANIC'8 61BN g' j (1 ~ ~ ~ r~ ~'~ f+utfman aMl ielton & Welf Waitnn, t/R. 6$f5!
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<br />an sand`, N'elir-:~ b88DZ .................._.......
<br />Rddress...-..._ .................._......--..-.........__.................................
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<br />Agairr.M:..-- Da .. 1_-Wilhelmi
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<br />~ i Far_c_oncrete a~d_bui.ldingmaterials
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<br /> furnished for residential construction ~9i3 8U ~
<br /> _____ ______________________~,See attached itemized state nt
<br /> marked Exhibit A and into area h e n
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<br />State of.-._..Nebraska i
<br />3 Hall }ss.
<br />.4t~, Robert_ M. - Pe hek~ -5scretary-Manager of HoQ~e -Lumber -Company b~~ ~~
<br />dxdy saearn, are his oath saps that the foregoing ite»dred account of work, tabor, skill_--.._-..-._..---__--°-•---°-------- ...............
<br />xeattrialr, and ixegontmextt is true axd correct,- that soxu west do»e axd perfor-rxed and furxirhed by the undersignsd
<br />tar the said.-.-Daryl -Wilhelmi_......---------- ............... .
<br />carder a' .---~ VErb2~.....-...-._......._.........-----.. ca»tracc-..-.._...
<br />~,,, tker -materials residence
<br />vn the following lot, piece ar jmreel of rand, taz:°........~$$g.,-~Xill,hi.G_.A..,~t~3C~18Sf...~xt:.~Q3
<br />t That at the tixse said caxhact et+os nuedr and labor asd »wterwtf3 fur»irkrd axd delivered therexxdn ........................
<br />....Darryl-_Wilhelmi, _. ...._..w+os the ownrr of said ¢renrises'
<br />That the date of alts first iteix furwishsd anal dafi+~ersd zvbs-AugusC ..?y.,--.198. -..._ ...................... and the
<br />date of the fast itcur uns....,t~Q.V.~....~-~..-1.,85}..._ - -- -- -.....__._.... - - ............ - -.._...-- -°-- ........ ,
<br />A~iand turthn state: that said faLor aus Qrrforxrsd on, a»d materials were furnished for, delivered at, and used in
<br />raid builrliny or gsnrites on axd betiueex the dates sgecijed.
<br />Thor the gicss chaegsd therrfvr ~e far and rsasanable, area that there is aaw due on said atcount tits sine of
<br />Nine hundred thirteen and BDjlt)C-----------------..___..____-- .1?otlars, that said°
<br />__..-._....---__..-.._ ....................._.-----..... -..._ ._......_....--.-._....... _ .ctairru a liar on the said prsrnitrs for the full anrorent of j
<br />atad atco~tt, to-~t: The sane of ~..9~3.e~C~ ......................_...---.---..._tagether atrith ixterest thsreox at the Isgat rots, 1
<br />fraae tha .....................°.day af._....._......._...._..~.......-........._ - ---......._.._....-. 80
<br />5th November ..~- ., t9_._---_.., axd further arrant says not. !
<br />- - E LUMBER ANY ':
<br />itfWA-IIiR~'111lYiMkias- ~'---..._-._........ ~.~.... .-I_~-! r-:S+~Y. __ `
<br />Secretor -i+fana er ~......... ----~........~ ................•-' -
<br />,w~eca~ora ...._ ---- -..-._ .....................................y...._..,-... 8.--- .....-....._.._ __ _ qq
<br />~` ts~letis ff. auurcribed in my gssrnce and sworn to befort nrr ' ....-.. v..a.l....._._-------.._.-...._
<br />day of -_.- - - - _......:~A.el......._. _- .... ,._.._ :_-... , ty.8~....
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<br />t See trustee fat instruetiotra) ! Notary Public,
<br />frTY`ATS t~:,......._ _...-.....__.._..... _.-..... ~ re. Fdntered vn nuureriaai itwiex and filed for reaYrrd
<br />....................._..--.--.__._....__.._,-._ ,._.._.-._ 1 in t!k i{rrxuter o/ LAcrte (Mice of said County tha ~ -
<br />-.,,.... _..:...~._-..~i ctl . ............. . .. . .._.,._..... -..... 19..-, ..._, ®t., ........ _.........o'clack ansL., .. -. rrdnuid .. .. _. ~3.,
<br />xrsd reed is i3eait._._.._........ -_. .___.ot....... _....... _ .._. ,at pitta. _ . .._ _ _ _ ;
<br />....... ...... ... . ..... . ~--... -. ... fret. of I)e!edr
<br />fly.-. i)eputy
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