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� <br />� <br />N � <br />0 � <br />� <br />� � <br />0 <br />N � <br />Cn <br />W � <br />GJ - <br />� <br />CLAIMANT: , � <br />���o,� 1�4?D�1�1�,--f_1Nf�-`--�`'( ��:'�yn�c� <br />1 <br />(Name) �V.. ..�i v`'�'� <br />............ .... . -�-------------..............._......._.._....---............. <br />(Address) v----.�...�-`--��--"."-�......--�-��---------------- <br />C�g� --.----�� - g �:� � ...................... ......................... <br />(Phone) <br />REAL ESTATE: <br />� 3v <br />, - <br />---�--�� � �� � ----�-- <br />(Legal Deecript�on� ��' � �,� , r <br />�----------------•-- -- �----�--�--�--�--� ----�---�----.....----...--�---�---�---�- --------�-----...... <br />. C:��t.--�-b�---�.��D....��-�--�--�.--------- <br />CLAIMANT CONTRACTED WITH: , <br />-----�-� --- � r''!' !� ... J �''`,�T � ................. <br />(Name) �l g � t t�t � � <br />-----��-�--�-----�-�- -------------------�--�-- ....- ---�- - - .. <br />(Addresa � -- ��� --- .i�S 1.11'""��.�....�+' ��.�_-- <br />. .. <br />C��..3. $.�- � �'� 3bg -3?q- 6� <br />(Phone) � ��SJ ���' ���.�.�.......---•--- <br />' . {�,,�_ / j' A'l� �. �l.t�,-o� �6i�1 • . i I <br />SERV;CES OR MAT�RIAI.S FUPNISHEU EI' �LAINIARTT: !,/(!7�77.`..�..1��-------��---.....-.-�--�--.....-------�-----�--�--------- -� <br />' �,�,� u, � �a� �;�� � ��OPs �n �.�- � e� � P�P�r��o s�► �2 �r P�.�c Po�r <br />-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------- ; <br />. <br />, <br />�� ��..��� �'� ��}t�J� �D ���� �--s.-`!�`�---�`'-�=a-------------------------------------------------------------------- ;i <br />. .. ................................................ .. .. . <br />------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ : <br />CONTRACT PRICE: $....17�0'1'� ��� ....................... AMOUNT UNPAID: $.��.'"-t''�'�r�------.--....------- i� <br />'{ ��..�at..:�:--°--�-------------------------------------------------------------------------- '; <br />TIME LAST SERVICES OR MATERIALS FURNISHED : ...... ...... <br />,; <br />' State of . c �%�'"'"•'..�.�Q� <br />; <br />� <br />.�iCL ' ; <br />........•-• ............ .................... . ----........ ' ", <br />' ss. •- -•- --•----- •- ---••---------• - ••- •--- • -� -- -- <br />...............���...__._._......County Signature of Claimant <br />On this .... �``'�.8ay of _... �-�`J�� .................................. .� ��. , before me a Notary Public in and for '`, <br />� <br />said county, personally came ..... ............... .................................................................. to me known to be the identical person or ;� <br />persone who executed the foregoing inatrument, and acknowledged the same to be his, her, or their voluntary act and <br />deed. � � �� . � i <br />� ; <br />CaarN. �5�2011 --- ---------------------------------------------------��----------��-�----------�-�---�-�--�--- �------ � <br />Notary Public. <br />, �� � <br />My commisaion expires the--------- �----.---day of._...�.-��.��-�---------------------------------� `�� <br />VSTRUCTION LIEN <br />�G G <br />C3� <br />� � � <br />� � � <br />� � � <br />oa � <br />� � <br />� <br />� <br />� <br />Z <br />r"' v <br />�� <br />_ � <br />�� <br />;'i <br />C <br />201102533 <br />CONTRACTING OWNER OR SUCCESSOR, IN <br />INTEREST: <br />. <br />.����-�-- �---`��rt.... �.u l �C .............. <br />(Name) �� 8' � p �'Q Tt� .�'1 . <br />� -----�---�--�� .................................�----�---------��-�----�---�---------�------------------- <br />�� ��.�!�►...:��.-�--��°1......--.--. <br />STATEOF --------� ........................................................... <br />County ........--�---� ...............�-------..........-�-�--------.......... ss. <br />Entered on numerical index and filed for record <br />in the Register of Deeds Office of said County the <br />.......-�-�-�---�--day o£ .................................�-----� 19 -�--�--��-�-> at-�----.....------�------.....---------o'clock and..------......-----.....minutea......-------- ...M., <br />and recorded in Book ..................�-----�----of....-�-----�----��-----------.at page--------.. <br />------------------------------------------------------�-�------�----�--�---....R.eg. of Deeda <br />BY ••••-• ...........................•••.---......._.................----.....-----....... Deputy <br />Huffrnan and Felton & Wolf, Walton, Ne. 68461 <br />� <br />� n � O <br />� ,.�. O —! <br />� N <br />� ,r� � � rn d <br />.-- , ., . � � o <br />c-, �: . F—' <br />,-, , CJ O <br />� �; .._ �.� - � � �, . <br />� , , . . = r* , o <br />n n,:: . � <br />��/ � D � N <br />�^°7 ' -� � � ( <br />o f __ � � 7'� � <br />D (�,,) <br />p ;� ..,.. � ...i �.... <br />Gt� � <br />o �" � (3� <br />c�'s <br />` Rev. 8/95 <br />