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JSTRi ICTION LIEN __ - _. _ ~ Jacob Norkh Prlnti~Co., Inc., Lincoln, NE 58524 <br />~~ <br />~~ <br />~~ n~ ~ <br />~' ~,,; n• ~ r^ ,-~~ ~ ~ ~~" rya <br />~ ~ ~ ~ rri " "~ n cx~ o <br />~ ~ ~ r. ~ ~ r a7- rv <br />,.,.,,.,.,~.. ~ 4 rv ~ cn <br />n <br />---- ~ o ~ ~ <br />~I <br />2oioo2~s7 5~y~~ <br />CONTRACTING OWNER OR SUCCESSOR IN <br />INTEREST: REAL ESTATE: <br />(Name) • _~~ <br />---------------- ~_ R_.....~~.~-~Y..~...~~../. .~.-----~-~~_~I <br />...............~~...r~:n~ -.~$-,..--~--G.....~.~.~~..-.~~.~ <br />(Legal Description) , <br />CLAIMANT: ~y~/~. CLAIMANT CONTRACTED WITH: <br />r i... ' V 1 ~ G ~ ~ ~ r <br />.....~Y?1~:+r.'_~_~4.~~...~':~yl~~.....~?....-•------- -~'~eiin.t~.~...2.. ----- --~-----~5----- -- ~~!-.l'.~.~.~----1 o u~2 J-~"~~..v_~.._..... <br />(Name) ~ ~$ ~ (Name) <br />(Address) ,{~ ' , ` ~ (Address) ~ ~ ~ ~ <br />.....................aJ.ry~4~i'.?.q..,.....1~1.~...~o..~/F..l..~........... ------- --------------.._.__-~~..'.C..4r..7G?~..~5~...~L....(o~S~!D,.1...a...5.~. <br />---------.~!o....~~ 9~-.~7.a~ ............................................ -•------..-.----~a~.-.3~4.-.~.~~..o........................................... <br />(Phone) (Phone) <br />SERVICES OR MATERIALS FURNISHED BY CLAIMANT: .~C1~~~1~G:Y.....!`...-QC.~~.y~~~,,..- ........................ <br />.~. ~7..........~..,~...~.?~J.. r <br />CONTRACT PRICE: $------_a.~j..a.9O~._-OS--•_------ AMOUNT UNPAID: $...__-~t...~.Lo~.~..~~ ............... <br />TIME LAST SERVICES OR MATERIALS FURNISHED: ----.._~~...r~. a.r. a~~ ~--------------------------------------------------------------- <br />State of ....I~:~/1~.~.k,.~- .................... ~~[~~ ~y~ <br />--____-- `?azY~_~~ .............................Countyy Signature of Claimant <br />On this .....~..~-~ .............. day of ........f ~I.~II.Y_~1._~.......Q------.............----/------------------------ , ~dl o, before me a Notary Public in and for <br />said county, personally came .___~.R:Y.'..~?~:Q-...~]_{__~_~ ~~p(~QY..7..... 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 />.... ..... ..1~:.:1..... ~ ................ ...................--• •-•-- <br />t>~RAL NpTARY • &tata at Nebr <br />bE80HAH C. Jt1RA <br />My commission expires the........ °~. ~.-..........day o£.... ~.~ ~ .............................. °. {C~~ ~. My Camm. Fxp. Sept. 28, 20 <br />STATE OF --------------------------------- ---------• <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------..._................------........, <br />and recorded in Book .............................of __-- <br />_____________ at____.. ...-o'clock and__ <br />--•----at page ............................... <br />...........minutes ..................M., <br />...................... ..........Reg. of Deeds <br />By ---------------------•----------...............................................-•---- <br />,.. ~ <br />