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�. <br />� ) NSTRUCTIQN LIEN <br />�� mm <br />�� � � �r <br />N - � G � <br />�� � � � <br />..a. �.�.. � c v �`►-� <br />� �..�. ("'s. <br />m � <br />� � � � � <br />�1 � /� <br />�1 � � G � i <br />�� � J b <br />�rr � <br />� � � � <br />� � �� �. <br />�� � <br />__ . . l � - �.. ' G <br />l7J J <br />�;- <br />� �� <br />I � <br />� <br />_.,. _ � ;,._ . ...:. <br />1. The xeal estate subject to this lien is: '��' �' ��.�� /��v°�, GJr� �c�.:r��� C � f�,� . <br />J c��rY f� ,,� �:{ .� � � :.�� <br />� <br />2. The person against whose interest in the real estate the lien is claixned is: �"�`' S�d �`�� <br />/� L� Lc.i j �/f' r•� <br />3. The name and address of the claimazxt is: u�� � r �: `� ,;, G v� �°� �� , s�� <br />4. 1'he nazne and address of the person with whom the clai.mant contr�cted is: <br />�..,� Y["�� ..— ,� �n v'� c. ��V :cS", � � / �' " <br />I 5. A general description of the claimant's services perforrned to, to be performed or materials furnished or to be <br />� furnisheci for the improvement and the contract price is: <br />� / 1 / � / � <br />i �.!� �v •.r � �., <` ,l.r �.��; - �� . ��i r- [; :� .� Tw uc� Y��c •'1 �, �... � �-'� �, �, ._f�.� 7, G;, <br />� <br />3 - <br />� � r / ��J' � �`� <br />i ._' - C � f �,/ � � .. " 7 . •C `---� � � <br />' � „ r r ...__ � `...._._W.� <br />_ ° ' --1_ � �9 v N <br />�- _.._ .._.. .__.._.,.� <br />� 6. (Complete one of the followi.ng) <br />! � �,,.� <br />The arnount unpaid, whether due or not, to the claimant for the services or xnaterials is $' 6�� � . <br />The unpaid amount is not fixed by the contract, but a good faith estimat� in the amount of $ <br />7. (Complete one of the followin�) <br />The time the la�t services or matexifxls were fuxnished was �� `� t� '/�� <br />The time the last set�vices or materials were furnished has not yet occurred but is estimated to accur <br />L.._ / ! <br />. A�"„z' /-, ,�-� <br />� <br />� <br />�, <br />c <br />� n � <br />� � .. <br />� � <br />� <br />Ct a�, <br />��' <br />� �' <br />.� <br />�I <br />9 <br />� <br />2�11U0�.15 <br />CONSTRUCTTQN LIEN <br />Jacob North Printin� Co�, Inc., l <br />:�� <br />� c> cn <br />F - � � <br />��M � � <br />�:.] � �'Y =�? 4{ <br />�. � � � ..-{ rn <br />�'� �- � c.•� <br />� �, <br />� �� � �, -.� <br />� �; � { . r , <br />rn � —� � c� <br />�'� � r � <br />a �"-' A <br />cr' F--� cn <br />l ' (� � <br />A <br />� �w <br />� � <br />� <br />NE 68524 <br />C'7 <br />h� <br />� <br />� <br />� <br />Q <br />0 <br />f--^'► <br />F—� <br />� <br />� jD <br />, <br />Si�'nature o£ Claimant , <br />Subscribed and sworn to before me thie <br />- �ra� <br />or�s r. e+� <br />�II�IL in.11 x012 <br />I <br />r <br />� <br />� <br />r- � / / � � � <br />��/�-W`u o...yt ��c Ts-!n �' ✓� , � � � L� <br />7 � <br />�k f� � �• � � G � ., � � ��� s �"� . � -� � .. ; <br />2 - , ��. ; <br />.. __ day . <br />_ . . ..� . �_�.� ; <br />Notary Public ; <br />i <br />i(52-147. See 52-148 for amendment; 52-149 for assignment; 52-137 for recording time; 52-154 for discharge or release). <br />i <br />ir <br />;� <br />Rev. 9/9� <br />