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�� <br />.� <br />� <br />- <br />..� <br />�. - <br />� <br />� <br />� - <br />� — <br />�� <br />.� <br />- <br />- <br />LIEN <br />� <br />� <br />� <br />� <br />T� <br />�''J <br />� <br />� <br />;�0�.1079�1 <br />� <br />� <br />� <br />� � <br />� <br />`.Y.: <br />',�v, <br />��. <br />I <br />i. <br />CONSTRUCTION LIEN <br />a <br />D <br />r <br />r �- <br />� <br />0 <br />� �"° <br />r*t �.. <br />� }�G <br />� <br />m <br />� <br />°� (`� <br />o � <br />m <br />b <br />� <br />^T <br />r�� <br />/-�i <br />� <br />� <br />� <br />N <br />G!7 <br />e <br />3 <br />� <br />F--� <br />� <br />�' - � <br />� ""'+ <br />G D <br />� m <br />--i <br />-< p <br />O �7 <br />� z <br />� � <br />�- � <br />r � <br />r x9. <br />� <br />x <br />D <br />� <br />E1J <br />� <br />N <br />O <br />F--� <br />F—► <br />O <br />� <br />C:� <br />C7D <br />� <br />1. The real estate aubject to this lien is: �drQ.S �. �a�� L o� 93 �'tu ts�- �' � o �w�..�.e..� t��t. <br />2. The person against whose intere.st in the real �tate the lien is claimPCl is: �� �+� 1- ����t-� <br />3. The name and address of the claimant ia: l s� .� d� m a� "tJ� �� �.���� (� <br />��°��'� Ia� �� 2 �$�� �fbdi K�5 4��h� d� �w�s .�u a c�.� <br />4. The name and address of the person with whom the claimant contractecl is: tirr►°►a� � �r" Q <br />�2'3� _ ' C�k 5�. ��,.��s��� c� <br />5. A general deacription of the claimant's services performed to, to }� performed or materials furnished or to be <br />furnished for the improvement and the contract price is: <br />_ l`��9� QC � nn _ �.��9-A� � 1 i(�- -�('r�r�w-, �1��� � �T'_c...e/� � <br />6. (Complete one of the foIlowing) <br />� The amount unpaid, whether due or not, to the claimant for the servic� or materials is $_ � <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 service.s or materials were furnished was �"_ /�� � J'� � 1 . <br />The time the last services or materials were furnished has not yet oc�urred but ia e.atimated to occur <br />A <br />� � � <br />_.,p <br />Signature of Claimant <br />Subscrib� and sworn to before me thie °��' day of , 0 ! <br />�ILL.IdOTARY-��Nebr�t� �' �� �"°� <br />OENK� R. KRt� Notaxy Public <br />Co� . �� 2011 <br />(52-147. See 52-148 for amendment; 52-149 for assignment; 52-137 for recording time; 52-154 for discharge or release). <br />Rev. <br />