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�� <br />�� <br />�� <br />0 �� <br />� ��� <br />0 <br />� <br />� - <br />� - <br />�� <br />�� <br />�� <br />.�� <br />�� <br />�� <br />LIEN <br />�D � � .� <br />� � � <br />� � � <br />� �. <br />� � � <br />� � � <br />_` � � <br />� <br />� � � <br />� <br />� <br />� <br />, F 7" <br />�. 1 <br />_ <br />\ <br />� <br />� 0�.10'� 9� 0 CONSTRUCTION LIEN <br />�V ' <br />T� ��r Q .,,,� � <br />r c ° a � � <br />� '` -��-+ ..��� � <br />� � � ° � ~ <br />m � � z }_,, <br />� � z rn <br />� - � ID w O <br />� � � m � <br />o �?:� � � � <br />p �• D <br />fs'1 �a �...i.a.i �.. <br />'�' s �. � � � <br />1 <br />1. The real �tate subject to this lien is: �—�'1 �'T,�� 0����'X .,�/��9-�.. ✓ <br />��- t�f I�J����n�� P�k ,o� t� b d;���;�.- e+ �-�.�`�r, 1-��u.� �� <br />2. Tk�:e person against whose interest in the real �tate the lien is claimed is: 4� �i !�' - �. ����, <br />�jf�[�r►��� <br />3. The name and address of the claimant is: �t'+�� V a �� p-� � 3�� �� b�'� � <br />`� {�C�'1 �1 S�x►.g`��a► ' � 4 ���t...�'t �' �Le.c�O �2 �t! i C. l. <br />4. The name and addr�s of the person with whom the claimant cantracted is: �� ► �- ��✓v� �� <br />5. A gen�rral description of the claimant's services performed to, to be performed or materials furnished or to be <br />furnished for the improvement and the contract price is: ►' r` � <br />�1���� � r�t �.,b,�,.� <br />6. (Complete one of the following) <br />�. Trie amount unpaid, whether due or not, to the claimant for the services or materiala is $ <br />�' <br />The unpaid amount is not fixed by the contract, but a good faith estimate in the amount of $ <br />7. (Complete one of the following) <br />� The time the last services or materials were furnished was � u`c���, �2 ��� . <br />The time the last services or materials were furnished has not yet occurred but is �timated to occur <br />< <br />Signature of Claimant <br />Subscrib� and aworn to before me this ��� day of lJ% o�</ <br />� <br />G�NERRi. NOT�RY - S�te at Nebt�ka n�iyc,�--�gi /L. . <br />pENiCE R. KHUS� <br />�� ����� Notary blic <br />(52-147. Sce 52-148 for amendmen� 52-149 for assignment; 52-137 for recording time; 52-154 for discharge or release). <br />� <br />Re v. 9/9� <br />