TRANSMITTA L o f OMAH A LEA D SIT E PAIN T STABILIZATIO N FIL E FOLDE R SAID# : y^^^; ^ Date : n^/^rO./^a// y 

## Address : sfypTty f /?y:y9yxy/ ^ .^7- . Stabilizatio n Contractor : Pruden t Technologies , Inc . Year : 2010 _ PAIN T STABILIZATIO N PROPERT Y FIL E FOLDE RDOCUMENT S yZ Vide o o f propert y (DVD ) ' yZ Executiv e Summar y y Signe dAcces s Agreement fo r subjec t propert y yy

\Pre-Renovatio n For msigne db y Propert y Owne r

• Pre-Renovatio n For mfo r Occupant/Tenant , ifappiicabl e 

# z Paintin g Agreement D Settlement document s (i.e. , fo r damag e o r t o replac e plants , etc. ) yy f Renovatio n Recordkeepin g Checklis t signe db y Certifie dRenovato r yZ Photograph s y Satisfactor y close-ou t chec k lis t signe db y Propert y Owne r D Propert y close-out chec k lis t signe db y EP A J

G Propert y informatio n fromDougla s Count y Assessor' s Offic e j t Hazar danalysis , i f prepare d D Safet y Audi t n Other (describe) :

K . Signature Dat e (afie r file folde r review ) 3021811 5 

# HI HMNl l Superfun dTECHNOLOGIES ^ IN C 

## Propert y Summar y Date : 8/11/201 0 LB P STABILIZATIO N EP A CONTRAC T EP-R7-08-0 7 Mont h of : Augus t Propert y Address ; 121 0 Blain e St . SAI D # : 1232 7
A . Executiv e Summarv : a . Issue s Encountered : NON E b . Issue s Resolved : NON E c . Uniqu e Findings : NON E d . Othe r Relevan t Information : i . Acces s Date : 06/13/201 0 ii . Wor k Began : 06/29/201 0 iii . Close-Ou t Date : 06/29/201 0 B . Enclosures : 1 . Pre-Stabilizatio n Vide o 2 . Post-Stabilizatio n Vide o 3 . Signe dAcces s Agreemen t Form 4 . Pr e - Renovatio n Formsigne db y Propert y Owne r 5 . Pr e - Renovatio n Formsigne db y Occupant / Tenant , if applicabl e 6 . Advance-Notice , Stabilizatio n Vide o Agreemen t For m 7 . Propert y Pain t Matc h Form 8 . Propert y Acces s Assessment Form 9 . Renovatio n Recordkeepin g Checklis t signe dby Certifie dRenovato r 10 . Signe dPropert y Completio n Agreemen t Form 11 . Propert y Close-Ou t Chec k lis t Signe dby EPA 12 . Dougla s County Assesso r Propert y Informatio n 13 . Work-Sit e Hazard s Analysi s Checklis t 14 . Pre

- Stabilizatio n Propert y Hazar dAssessment Photograph sTECHNOUXSIBS , INC T 

### Pruden t Technologies , Inc . (Prudent ) i s unde r

contrac t (Contract #EP-R7-08-07 ) wit h the U . S . Environmenta l Protectio n Agency (EPA) t o stabiliz e Lea dBasedPain t (LBP) a t anumbe r

ofpropertie s locate din Omaha , Nebraska , including di e propert y locate dat : /g^l Q J^hjiyi ^ S ^ Th e EP A request s you r

permissio n to allo w Pruden t t

o perfor mLB P Stabilizatio n a t thi s property . B y signing thi s form , the propert y owne r

grant s permissio n to Pruden t to perfor mactivitie s relate dto LB P Stabilizatio n including scraping paint andpaintin g ofth e referencedproperty . Further , th e owner/tenan t verifie s tha t they hav e receive dth e LB P pamphle t "Renovat e Right. " B y signing thi s documen t I agre e t o allo w a n EP A contracto r

to conduct asoil cleanu p a t m y propert y following completion of lead-base dpaint stabilization , i f th e soil cleanu p ha s no t alread y bee n performed . I imderstandtha t th e stabilizatio n contractor cannot provide assurance s o f which contractor will b e boundto the soil cleanup . I furthe r

understandtha t th e soil cleanu p contractor will mak e all reasonabl e efforts to addres s concem s tha t I , a s th e propert y owner , ma y hav e regarding soil cleanu p a t m y property . [rZ \Yes , I hav e rea dan dunderstandth e paragraph above . 

# 0^-1'^'1^/ 0 wner' s Signatur e Dat e Ifyo u hav e an y question s abou t the LB P stabilizatio n plannedfo r

you r

property , pleas e contact Prudent' s Custome r

Relations/Offic e Manage r

fo r

th e Lea dBase dPain t Stabilization , Mr . Chandr a Sheka r a

t 402

- 504-100 4 o r 402-889-3821 . Genera l question s abou t th e OmahaLea dSit e cleanu p ca n b e directe dto the EP A Publi c Information Center s a t (402 ) 731-304 5 (Sout h Omahaoffice) o r

(402 ) 991-958 3 (Nort h Omahaoffice) . Propert v Acces s Grante dBv : 

# OlzIhW D Propert y Owner' s Signatur e Dat e 

# n o«^i r, V \A J <»vVhr A( L c Af^/ d Pleas e Prin t Nam e

808 0 War d Parkway , Suit e 40 5 250 5 N
. 24' " Street , Suit e 30 8 424 2 IVledica l Drive , Suit e 425 0 Kansa s City , WI O 6411 4 Omaha , Nebrask a 6811 0 Sa n Antonio , T X 7822 9 Phone : (816 ) 363-370 3 Phone : (402)504-100 4 Phone : (210)822-958 8 Fax : (816 ) 363-370 7 Fax : (402)504-100 5 Fax:(210)579-657 7TBCHNOUXilBS.TN C 

### PROPERT Y INFORMATIO N (T o b e complete db y residen t and/o r propert y owne r ~ pleas e print ) RESIDEN T NAME : 

## Mr^/Tc

- \/(iA<^Tif \C

- (^e ^ Tenan t RESIDEN T ADDRESS : )1}7 ) l^lcc ( r^g

- ^ 7~

I FRENTAL , PROPERT Y OWNE D BY : /^r^^cIc A l/rjJ.^r \J I < \( ^ OWNER' S MAILIN G ADDRESS : J'^I H "^{c^yrv ^ S' :
OWNER' S TELEPHON E NUMBER : Home : Work : 

## cd\:yy^2 706r-^y^ d NUMBE RO FOCCUPANTS UNDE R7 YEAR S OLD : 3 TOTA L NUMBE RO FOCCUPANTS : ^ NUMBE RO FCHILDRE N UNDE R7 YEAR S OL D WH O PLA Y I N TH E YAR D FOR5 HOUR S O

RMOR E PE RWEEK : 3 COMMENT S O RSPECIA L INSTRUCTION S (suc h a s dogs , entr y gates , etc.) ;

AUTHORIT Y FORENVIRONMENTA L RESPONS E ACTIONS : The activitie s t o b e implemented by EP A unde r

thi s agreemen t ar e pursuan t to Section 10 4 ofCERCLA , 4 2 U.S.C . 9604 . EPA' s righ t ofacces s to th e propert y i s providedfo r

in Section 104(e ) ofCERCLA , 4 2 U.S . C 9605(e) , which provide s entr y fo r

"detenninin g the needfo r

response , or choosing or takin g an y respons e actio n unde r thi s title , or othenvis e enforcing the provision s ofth e title. " Propert y Owne r

Signature : 

### OIP-12

- tCl ^ (Signature ) Dat e 808 0 War d Parkway , Suit e 40 5 250 5 N
. 24' " Street , Suit e 30 8 424 2 Medica l Drive , Suit e 425 0 Kansa s City , M O 6411 4 Omaha , Nebrask a 6811 0 Sa n Antonio , T X 7822 9 Phone : (816 ) 363-370 3 Phone : (402)504-100 4 Phone : (210)822-958 8 Fax : (816 ) 363-370 7 Fax : (402)504-100 5 Fax : (210 ) 579-657 7

### PR E & POS T PAIN T STABILIZATIO N VIDE O AN D PICTURE S I understan d that pruden t Technologie s (Prudent ) wil l b e comin g ou t t o shoo t a Pre Stabilizatio n vide o an d t o take picture s o f m y property . Pruden t wil l us e th e video s an d picture s t o documen t th e curren t propert y status/condition
. Also , Pruden t wil l shoot a vide o sho t followin g th e compietio n of th e pain t stabilization
. I give permissio n t o video s an d picture s of my property . Pleas e lis t an y specia l condition s that Pruden t employee s nee d t o b e awar e o f befor e shootin g a vide o (suc h as pets , prio rnotice , etc.)
.



# iiiz ) 1^;^.^ ^ Propert y Addres s 

# s i

Owner' s Nam e Signature 

# n6-ll-%f?/ d Dat e ADVANC E NOTIC E REQUIREMEN T Afte rsignin g th e acces s yo u allo w Pruden t t o begi n Lea d Base d Pain t Stabilization
. Al l Plants , weed s an d an y vehicle s o ritem s o n ope n porc h (enclose d porche s wil l NO T b e stabilized ) must b e remove d prio rt o stabilization
. Al l Pets must b e ou t o f yard durin g stabilization
. Pleas e indicat e below ho w muc h advance notic e yo u nee d t o have th e above mentione d task s completed
. I f yo u are a landlor d yo u wil l nee d t o contac t th e tenan t as Pruden t wil l onl y infor m th e propert y owners . D o yo u have an y pets tha t resid e i n yard : Notic e needed : Phon e numbe rt o cal l t o give notice : W f - '^0{ Q \y)^^'0 O Who m w e are givin g notic e to :

808 0 War d Parkway , Suit e 40 5 250 5 N
. 24' " Street , Suit e 30 8 424 2 Medica l Drive , Suit e 425 0 Kansa s City , M O 6411 4 Omaha , Nebrask a 6811 0 Sa n Antonio , T X 7822 9 Phone : (816 ) 363-370 3 Phone : (402 ) 504-100 4 Phone : (210)822-958 8 Fax : (816 ) 363-370 7 Fax : (402)504-100 5 Fax:(210)579-657 7

### PRE-RENOVATIO N FOR M - OWNE R Thi s for mi s to b e usedb y the firms contractedb y th e Environmenta l Protection Agency-Region 7 t o perfor mLead-Based Pain t stabilizatio n activitie s a t th e OmahaLea dSite , Omaha , Nebraska . Owne r Confirmatio n Pamphle t Receip t p I hav e receivedacop y ofth e lea dhazar dinformatio n pamphlet , Renovat e Right : Importan dLea dHazar dInformation fo r Families , Chil dCare Provider s an dSchools , informin g m e ofth e potentia l ris k ofth e lea dhazar dexposur e fro mrenovatio n activit y t o b e performe din/on m y dwelling unit . I receivedthi s pamphle t befor e th e wor k

began . Owne r Acknowledgmen t 0(A ) I confir mtha t I ow n an dliv e i n thi s property , tha t no chil dunde r th e ag e of 6 reside s here , tha t n o pregnan t woma n reside s here , an dtha t thi s propert y i s no t achild-occupiedfacility . Note : A chil dreside s i n the primar y residenc e o f his/he r custodia l parents , lega l guardians , foste r parents , or informa l caretake r i

f th e childlive s an dsleep s mos t of time a t th e caretaker' s residence . Note : A child-occupiedfacilit y i s apre-197 8 buildin g visite dregularl y b y th e sam e child , unde r 6 year s o f age , o n a t leas t tw o differen t day s within an y week , fo r a

t leas t 3 hour s each day , providedtha t th e visit s tota l at leas t 6 0 hour s annually . D (B ) I understandtha t th e renovation fum , contractedby th e Environmenta l Protection Agency (EPA) , will be using lead

saf e wor k

practice s requiredb y EPA' s Renovation , Repai r an dPainting Rule . 

## \/cA^yy , y\ . ^^^ i g ^ Printe dNam e o f Owner-Occupan t 

# ^- /^ - 

# 2^/ ^ Signatur e o f Owner-Occupan t Dat e

### PAIN T MATCHIN G FORM : 1 . T O B E FILLE D OU T ONL Y I FMATCHIN G COLO R PROPERT Y ADDRESS : lll O ^V.i.v>r^€. ^ T BVID : Th e followin g note s ar e fo r th e benefi t o f pain t cre w only . Pain t Ye s Pain t N o Locatio n Pain t Descriptio n Siding 

# L ^ Vi<vY l Soffi t U J 0 e ( ^ Fasci a \A > o 

### ^ d Come r Tri m vy><^^_ ^ Window Trim s K.) ^ fi A j ^ Doo r Trim s ^^o^ ^ j:^:r ^ Fron t Porc h Ceiling o o i k 

# y Fron t Porc h Ceiling Beams X.SJ 0 ^ A . 

# l ^ Fron t Porc h Floor 

# l ^ LA / 0 * A Front Porc h Railing s UN/

- » © Fron t Porc h Step s » ^ e > » c ( Siding Baseboard s vJ\ V Foundation C<./VU<^A-J| — Garage/Shed 

# Oltv

- 

# L ^

^^ t^-ti<i.y s wCftdo*^' ^ V(5<K :

• I UNDERSTAN D SHERWI N WILLIAM S WIL L MATC H M Y CURREN T COLORS .
Homeowne r signature ; Date : 808 0 War d Parkway , Suit e 40 5 250 5 N
. 24' " Street , Suit e 30 8 424 2 Medica l Drive , Suit e 425 0 Kansa s City , M O 6411 4 Omaha , Nebrask a 6811 0 Sa n Antonio , T X 7822 9 Phone:(816)363-370 3 Phone : (402 ) 504-100 4 Phone : (210)822-958 8 Fax:(816)363-370 7 Fax : (402 ) 504-100 5 Fax:(210)579-657 7

# pRlJDEr a TECHNOU}GISS,IN C ACCES S ASSESSMEN T FORM : /-^/ 6 Hous e sidin g (circl e al l applicable ) *Transit e i s sam e a s asbesto s **Als o calle d aluminu m sidin g ***Ais o calle d roo f shingle s I f th e sidin g i s aluminu m (metal) , I s i t origina l factor yfinis h o rpainte d over ? Circl e one . I f th e sidin g i s Wood/Asphalt/Roof shingles , i s i t painted ? Circl e one . Doe s thi s propert yrequir e lot s of scrapping ? Doe s thi s propert yrequir e a lif t o rscaffoldin g t o reac h uppe rlevels ? Doe s thi s propert yhav e lot s o f plants/iv yo ritem s i n th e area s where paintin g i s required ? I f ye s explain
. Doe s thi s propert yhav e an ysignifican t structura l damage ? I f yes . EXPLAIN ? Doe s thi s propert yhav e a : Garag e / She d Garage : Ye s / N o Shed : Ye s / N o I f yes , describ e th e locatio n & sidin g materia l o f garag e / shed
. I s thi s propert y vacan t o roccupie d - circl e on e Ar e there an y pets a t thi s property ? I f ye s explain
. Are ther e an ylo w hangin g powe rlines ? D o w e nee d neighbor' s access ? I f ye s pleas e explai n an d ge t neighbor' s propert yaddres s an d owne rinformation
. d>fa 7 n^.'f- ^ Woo d / Transite*(^yiny>/ Pre-finishe d Metal* * / Bric k /

Concret e / Concret e block s / woo d Shingles / Asphal t shingles** * / Stucco / Origina l Factor yFinish , Pairrte d Ove r Shingle s painte d Shingle s not painted" ^ Yes( / No j Ye s 

# (R > Ye s %

Ye s /I 

## '|Ko ) Garage : Attache d / Detache d Garag e siding : Woo d / Transite * / Viny l / Pre finishe d Metal* * / Bric k /

Concret e / Concret e block s / woo d shingle s / Asphal t shingles** * / Stucco / Shed : Occupl ^ /

Vacan t 

### Ye s i m Yds/N o Yes / 

# g j

808 0 War d Parkway , Suit e 40 5 250 5 N
. 24' " Street , Suit e 30 8 424 2 Medica l Drive , Suit e 425 0 Kansa s City , M O 6411 4 Omaha , Nebrask a 6811 0 Sa n Antonio , T X 7822 9 Phone : (816 ) 363-370 3 Phone : (402)504-100 4 Phone : (210)822-958 8 Fax:(816)363-370 7 Fax ; (402)504-100 5 Fax:(210)579-657 7(effectiv e Apri l 2010 )


### RENOVATIO N RECORDKEEPIN G CHECKLIS T
Nam e o f

Firm : -^fvuAi^J^ - Dat e an dLocation of Renovation : Star t Date : £ ^)l o En dDate : G 2.^|l o Location : \2J 0 BVxifA a^| ^ Brief Descriptio n of Renovation : •^^^^t>^ii^.\ " Nam e o f Assigne dRenovator : ^<jtmp ' (^O^Mie. 1 ^('^eJ l ''TiJCLirs . Name(s ) o f Traine dWorkers : T5<^«»^<'<? ^ Nam e o f Dus t Samplin g Technician , Inspector , and/o r Ris k Assessor , i f used : Copie s o f renovato r an ddus t samplin g technicia n qualification s (trainin g certificates , certifications ) o n file. Certifie drenovato r provide dtrainin g t o worker s o n (chec k al l tha t apply) : '^ Postin g warnin g sign s Settin g u p plasti c containmen t barrier s Maintainin g containmen t ^"" ^ Avoidin g sprea do f dus t t o adjacen t area s '-"-'Wast e handlin g '—"Post-renovatio n cleanin g Tes t kit s use db y certifie drenovato r t o determin e whethe r lea dwa s presen t o n component s affecte db y renovatio n (identif y kit s use dan ddescrib e samplin g location s an dresults : ,.^'Warnin g sign s poste da t entranc e t o wor k area . /"Wor k are acontaine dt o preven t sprea do f dus t an ddebris . (^Window s i n an dwithi n 2 0 fee t ofth e wor k are aar e close d ^Door s i n an dwithi n 2 0 fee t ofth e wor k area s ar e close dan dseale d / ^ Door s tha t mus t b e use di n th e wor k are aar e covere dt o allo w passag e bu t preven t sprea do f dust . ^ Groun dcovere db y plasti c sheetin g extendin g 1 0 fee t fromwor k are a- plasti c anchore dt o th e Suildin g an dweighte ddow n b y heav y objects ! I f

necessary , vertica l contaimnen t installe dt o preven t migratio n o f dus t an ddebri s t o adjacen t property . Wast e containe don-sit e an dwhil e bein g transporte doff-site .

Renovatio n Recordkeepin g Checklis t Omah a Lea d Sit e(effectiv e Apri l 2010 )

Wor k

sit e properl y cleane dafter renovation . "^Al l chip s an ddebri s picke dup , protectiv e sheetin g misted , folde ddirty sid e inward , an dtape dfor removal . Wor k

are aHEP A vacuume dt o ge t pain t chip s fro mgroun dsurface , i f necessary . Certifie drenovato r performe dpost-renovatio n cleanin g verificatio n (describ e results) :

1 certif y unde r penalt y of la w tha t th e above information i s tme an dcomplete .

Nam e an dTitl e Dat e

Renovatio n Recordkeepin g Checklis t Omah a Lea d Sit eENVIRONMENTA L & CONSTRUCTIO N TECHNOLOGIES , INC . SERVICE S 

### OMAHA LEA D BASE D PAIN T REMEDIATIO N Propert y Owne r Close-Ou t For m 201 0 (Lead-Base dPain t Stabilizatio n EP A Contrac t EP-R7-08-07 ) SAID : 

### jy^cjr^ ^ Property Address : -y ^/^ n ^Z^^^> ^ c^'T ' Owner' s Name : Ay/f^TC^y ^ L^^//^y ^ y^^^i / ^/9^/^yi O Performanc e Standards/Close-Ou t Criteri a YE S N O 1 . Wa s th e entir e structure(s ) painte dwith th e exceptio n o f th e stated , exclude dareas ? Thi s woul dinclud e paintin g o f othe r associate dfeature s includin g fascia , eaves , siding , al l trim , porches , bo x beams , columns , rails , an dexterio r surface s o f garages . 2 . Wa s al l scrapin g an dothe r preparatio n work complete dsatisfactorily ? 3 . Wer e al l require darea s ofth e structure(s ) prime da s neede dan dpainte dwit h tw o to p coats ? 4 . Wa s th e pain t product s utilize dequivalen t t o a2 5 year product/quality ? 5 . Ar e al l ofth e area s wher e contaminate dmaterial s hav e bee n spille dthoroughl y vacuumed/ cleaned ? 6 . Di dth e contracto r collect/vacuu mal l fallin g an dscrape dpain t chip s o n th e entir e property , roadways , alleyways , publi c acces s area s an dals o remov e an y othe r generate ddebris ? 7 . I s th e grass are atha t surround s th e structure(s ) i n reasonabl y goo dcondition ? 8 . Ar e al l item s suc h a s polyethylen e sheeting , ladders , pain t brushes , cones , barrie r tape , etc . properl y removed ? 9 . I s ther e an y evidenc e o f propert y damag e tha t was don e b y th e contractor ? An y propert y damag e need s t o b e complete dprio r t o th e EP A Close-Out . 10 . Ar e yo u satisfie dwit h th e work performed ? 11 . Ar e ther e an y property item s tha t wer e temporaril y re-locate db y th e contracto r tha t nee d t o b e move dback ? 12 . Ar e ther e an y (known ) lingerin g issue s wit h th e property owner(s ) tha t hav e bee n lef t unresolved ? Othe r Considerations/Property Owne r Discussions/Additiona l Wor k

tha t i s Required :

^ Property Owne r Signatur e Dat e 

### \g.forcL o i i Dat e Pruden t Technologies , Inc . Signatur e

808 0 War d Parkway , Suit e 40 5 250 5 N
. 24' " street . Suit e 21 8 424 2 Medica l Drive , Suit e 425 0 Kansa s City , M O 6411 4 Omaha , Nebrask a 6811 0 Sa n Antonio , T X 7822 9 Phone:(816)363-370 3 Phone : (402)504-100 4 Phone : (210)822-958 8 Fax : (816 ) 363-370 7 Fax : (402)504-100 5 Fax : (210 ) 579-657 7

# t Q\ttJ ^ Checklis t fo r th e Worksit e Hazar dAnalysi s Addres s Crew : 

## Date : to- y fi Ite m Hazar d, i Correctiv e Actio n i L Overhea dLine s 

### ci ^ 

# ^ z ) CHi : In-transi t Vehicl e Clearanc e Level s aroun dhig h wire s Vehicl e Clearanc e aroun d hig h wire s whe n workin g Phon e line s Cabl e line s Ga s Lin e Wate r Lin e Sewe r Lin e Septi c Tan k Propane/Butan e Acces s to/on Propert y 

# i ^ LL/M^Q'S L 

## 0-^ ^ 

## k^^/A ^ Neighbo r Acces s Require d L>l^- 0 Hig h Traffi c Are a Garag e Structure s 

### ico^^OciiU l LOaxlZ^^^Zj ^ rcL - hoj o 

# l^a-M'i-fe^^ l Foundatio n 

### <Ux^ , ui-*/-A> ~ Retainin g Wall s 

### tLwAjg< ^ Fence s 

# ^"^^^ff H Tree s 

### U/( \ 

### • haiJk : Foliag e Genera l Conditio n o f 

# i^t^-U.gri.^^yg ^ i\jtuJ k ^*- ^ Damage dAreas : sin k 

### -Ouu^o y ^^T ' holes/rotte dwoo d Sprinkle r Syste m Pet s Insect s itiim s Weathe r Conditi i Unsaf e drivin g condition s Unsaf e neighborhoo d *M\/es.e»ej\rm . MA\9%j\ » ^ f . t uli^AJ^ f 

### Cre w Forema n Safetv^Office r

coar < ojyea ^ _\gjro< rcie ) dreo r(X^CU T oOS C War d Parkway , Suit e 40 5 250 5 N
. 24' " Street , Suit e 30 8 424 2 Medica l Drive , Suit e 425 0 Kansa s City , M O 6411 4 Omaha , Nebrask a 6811 0 Sa n Antonio , T X 7822 9 Phone : (816 ) 363-370 3 Phone : (402 ) 504-100 4 Phone ; (210)822-958 8 Pdx : :816 j 363-370 7 Fax : (402)504-100 5 Fax : (210 ) 579-657 7

# Checklis t fo r th e

MtHiMiiliiAMii l

### Dougla s Count y Accoun t Infijcmatio n Pag e 1 of 3 ^jm a 

# n Dougla s County , Nebrask a Propert y Recor d - R193723000 0 Prin t Reoor t Vie w Interactiv e GI S Ma o Informatio n i s vali d a s o f 2010-5-2 8 Treasurer' s Ta xReoor t Ne w Featur e ^ - f r ^

Subdivisio n Sale s Searc h Owne r VALENTIN-CALIXT O MARI A 1 ETA L 121 0 BLAIN E S T OMAH A N E 68107-000 0 Propert y Informatio n Ke y Numbe r 372 3 000 0 1 9 Accoun t Type : Residentia l Parce l Numbe r 193723000 0 Parce l Address : 121 0 BLAIN E S T OMAH A N E 68107-000 0 Lega l Description : PAR KFORES T LO T 9 BLOC K1 0 N 1/ 2 L T 8 & S 1/ 2 5 0 X 12 0 Valu e Informatio n Lan d Improvemen t Tota l 201 0 $4,800.0 0 $57,800.0 0 $62,600.0 0 200 9 $4,800.0 0 $57,800.0 0 $62,600.0 0 200 8 $4,800.0 0 $35,200.0 0 $40,000.0 0 200 7 $4,800.0 0 $35,200.0 0 $40,000.0 0 200 6 $4,800.0 0 $35,200.0 0 $40,000.0 0 200 5 $4,800.0 0 $35,200.0 0 $40,000.0 0 Sale s Informatio n Sale s Date : 2008-12-0 5 Vie w Documen t Dee d Type : W D Book : 200 8 Page : 11936 9 Price : $ 65,000.0 0 Granto r SEMI N JOSEP H G ETA L Grantee : VALENTIN-CALIXT O MARI A 1 ETA L Vaiid/lnvalid : Vali d Exclusio n Reason : Lan d Informatio n Acre s S F Unit s Dept h Widt h Vacan t 0.1 3 6000. 0 1. 0 120. 0 50. 0 N o Improvemen t Informatio n 

### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountao=R193.. . 6/3/201 0Dougla s Count y Accoun t Informatio n tMjm a Pag e 2 of 3

Buildin g 1 1 1/ 2 Stw yUnfi n 121 0 BJErine S t

s r
Saf*va[-SMi^9( t B^3ss! t CLIC KTO ENLARG E IMAG E CLIC KT O ENLARG E IMAG E Squar e Footage : 836. 0 Percen t Complete : 100.0 % Perimete r 0. 0 Quality : Fai r Uni t Type : Condition : Goo d

Buil t As : 1 1/ 2 Stor yUnfi n Cond o Squar e Footage : 0. 0 HVAC : Force d Ai r Rooms : 5. 0 Exterior : Fram e Viny l Units : 1. 0 Interior : Drywal l Baths : 1. 0 Roo f Cover : Compositio n Shingl e Bedrooms : 2. 0

Roo f Type : Gabl e Stories : 1. 5 Floorcover : Allowanc e Foundation : Bloc k Sprinkle rSquar e Footage : 0. 0 Yea rBuil t Yea r Remodele d Percen t Remodele d Adjuste d Yea r Buil t Physica l Ag e 190 6 0 0 % 190 6 10 3 Detai l Typ e Detai l Descriptio n Unit s Ad d O n Unfinishe d Atti c W/floo r 836. 0 Applianc e Allowanc e 1. 0 Basemen t Bsmn t Bloc k 8 f t 836. 0 Fixtur e Bas e Fixture s 1. 0 Fixtur e Bat h Ful l 1. 0 Porc h Sla b Roo f Ceilin g 120. 0 Porc h Sla b Roo f Ceilin g 100. 0

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