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~ )NSTRUCTION LIEN Jacob Nor~inting Co, Inc„ Lincoln, NE 68524 -----...__._..... X1111 ~.,~ y _ ~J'r - ~,~ C ~ C~ war ,~ :U ~ ""-~ rYi G~ ~ ~ C ~ 6 ~ c~ ~ ~ ~ F-~ ~~ ~ ~ ~ ~ ~ CSC ~ ~~ "i '~ . , p ~ ~ ~ ~ •• Sy tx~ f~ - ~ m ~ L/1 m r"" :n ~ ~ ~ ~ ~ ~ Q rrr~ .~ '"7"i p ~ ~ ~~ CL1 ~ r!~1 wwww~ ~ ~, 2oioa3os~ CONSTRUCTION LIEN 1. The real estate subject to this lien is: _ u 4 ` a ~-~~1~ ~.~..1.. F ~ 1~2~~ ~ ~z-4-~~ ~-T ~ y ~ ~ _ ~U~a ~ 2. The person gainst whose interest in the real estate the lien is claimed is: ~ (~ ~j--'"~C-~ ~ 7 ~ `~ ~~ ( ~ GlL 3. The name and address of the claim t is: u~~ ~ ~ r -Z ~ 2 ~ Vz ~` ~~~ ~ 12 ~ 11 ..~~.• ~ ' /~~ - ~ U ~ ~ ~ + h ~ ~ dress of the person with whom the claimant contracted is: 4. The name and a 7 1// 1 ~~w, ~ 7 I^ f^ J~ L_~ ~1 /IC-'__ __ _ b_ YLL `~'~!' 1 ~- ~ ~ ~~-M-1 ~~1+ ~ ~ ~ ~' • ~ ~ 4 lY ~ ~O O _ 5. A eneral description of the claimant's services erforrned to be ggrfo med ar mater~'~.ls furni or to be 1 ~ a v ~.~ac~ ~. ~ __ v~~o.~ 1 ~ ~ furnished for the improvement and the contract price is: .. ` ~ 6. (Complete one of the following) pc~ The amount unpaid, whether due or not, to the claimant for the services or materials is $ r The unpaid amount is not fixed by the contract, but a good faith estimate in the amount of $ 7. (Complete one of the following) The time the last services or materials were furnished was ~ ~ ~ ~ 7 ~~~ The time the last services or materials were furnished has not yet occurred but is estimated to occur Signature of Claimant (~~ ~ ~~~So ~ ~ ~ v ~L u7 ~"~ ~-' ~ ~Ga rz.Y~4~ ~L ~U~ `~ ~' Subscribed and sworn to before me this day of ~'~ ~7 ~r~ l'. IirEN~RAL NOTARY - Stat9 Ot N86f~11A / . pATBY A KALKOWSKI ate, p . c My darn. E>tp. Ap1p 29, 20f 1 (52-147. See 52-148 for amendment; 52-149 for assignment; 52-137 for recording time; 52-154 for discharge or release). __.__. Rev. 9/9'~ IV W 07 N iii__ i ii-__ .