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� 3 <br />oO <br />200308164 <br />[..cts kxnek a <br />1. The real estate subject to this lien is: Crane Valley 3rd subdivision; Crane Valley <br />4th subdivision Lot 2 Shafer Medical Two LLC, Lot 3 Shafer Properties LLC~Crane <br />Valley 2nd subdivision, Lot 2 Shafer Development LLC. <br />2. The person against whose interest in the real estate the lien is claimed is: Joel <br />Shafer, Shafer Properties LLC, Shafer Development LLC, and Shafer Medical Two LLC. <br />3. The name and address of the claimant is: NCS Equipment, Inc Div. of DAB <br />Incorporated, 73779 Road 438 Bertrand, NE 68927, <br />4. The name and address of the person with whom the claimant contracted is: NCS <br />Equipment, Inc Div, of DAB Incorporated, 73779 Road 438 Bertrand, NE 68927, <br />5. A general description of the claimant's services performed or to be performed or <br />materials furnished or to be furnished for the improvement and the contract price <br />is: Forklift rental. <br />The total contract price is $ 14,127.73 <br />6. (Complete one of the following) <br />_The amount unpaid, whether due or not, to the claimant for the services <br />or materials is: $ 14,127.73 <br />The unpaid amount is not fixed by the contract, but a good faith estimate <br />in the amount of. $ <br />7. (Complete one of the following) <br />X The time the last services or materials were furnished was April 242 003. <br />The time the last services or materials were furnished has not yet occurred <br />but is estimated to occur <br />Claimant: NCS Equipment, Inc. Div. of DAB Incorporated <br />GENERAL NOTARY • S By' <br />State of Nebraska <br />I MICHELLE REMMENGA Q <br />_ My Comm. Exp. June 6, 2006 Its• <br />Subscribed and sworn to before me this day of t 2003 <br />N ary Public <br />M <br />f1 f1 <br />c> <r• <br />p <br />rn cn <br />" <br />Z � <br />N <br />�. <br />� <br />n�z= <br />M <br />CA <br />CA <br />co <br />r� <br />CP <br />F- <br />CD <br />U) <br />vu' <br />N <br />'L <br />O <br />co <br />200308164 <br />[..cts kxnek a <br />1. The real estate subject to this lien is: Crane Valley 3rd subdivision; Crane Valley <br />4th subdivision Lot 2 Shafer Medical Two LLC, Lot 3 Shafer Properties LLC~Crane <br />Valley 2nd subdivision, Lot 2 Shafer Development LLC. <br />2. The person against whose interest in the real estate the lien is claimed is: Joel <br />Shafer, Shafer Properties LLC, Shafer Development LLC, and Shafer Medical Two LLC. <br />3. The name and address of the claimant is: NCS Equipment, Inc Div. of DAB <br />Incorporated, 73779 Road 438 Bertrand, NE 68927, <br />4. The name and address of the person with whom the claimant contracted is: NCS <br />Equipment, Inc Div, of DAB Incorporated, 73779 Road 438 Bertrand, NE 68927, <br />5. A general description of the claimant's services performed or to be performed or <br />materials furnished or to be furnished for the improvement and the contract price <br />is: Forklift rental. <br />The total contract price is $ 14,127.73 <br />6. (Complete one of the following) <br />_The amount unpaid, whether due or not, to the claimant for the services <br />or materials is: $ 14,127.73 <br />The unpaid amount is not fixed by the contract, but a good faith estimate <br />in the amount of. $ <br />7. (Complete one of the following) <br />X The time the last services or materials were furnished was April 242 003. <br />The time the last services or materials were furnished has not yet occurred <br />but is estimated to occur <br />Claimant: NCS Equipment, Inc. Div. of DAB Incorporated <br />GENERAL NOTARY • S By' <br />State of Nebraska <br />I MICHELLE REMMENGA Q <br />_ My Comm. Exp. June 6, 2006 Its• <br />Subscribed and sworn to before me this day of t 2003 <br />N ary Public <br />