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P~,T'~ BUILDING ~,PF~CSAI~TIF~.:i ~ ~~.~.+~.e.t~_
(Narrte o/ Lier:ar }
370Q South FeL3e~ral :ii{~hway, rt. izrce, Flori_~a
(Residence or 13usiness Address of lienar)
being duly sworn says tha3 in pursuarccs of a contract avith .....~..r.Y`~~`D-_G~~~E~~T._.__.._
..,-_32,`?1-.South r_eri~ral ~iighw~v.r_Y Pt. Puree, ~loric~a .....
(11r'ame of L~ienar's Employer ar person with wham he carctracted)
` l~t~:~nnt
he j ~'~~~~ lh€ f adlourin,~ ~d (Mere describe the labor ar services performed ar
` f urt~ashed materials
materials turni.rhed. 1?escribe specially fabricated materials separateiy)._..~-'?:1_e,_._en~mel.,,._,va~rna~,
caul'rin;r, staples, paint, nails, ladders, chap, line refill, plywoo j,
-- ---c{~r.~,ent, sheet cork, sprints, trowels stains....puttyr.., wood cox~,~rr luza:Ler,
chisel, pine flooring and drip clothes. '; .~ _ ~ •,
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to the value o f ...... ~~-S 1 i . l F, .." .. °' ...............................•----...................-•-----•-----.._... J_, ' , ~' .... .~ ~~~
(State eantract ~irice) w~~ A~.. r
or. the f aldorving descrived peal property. (jJescribe real property su f iciently f nr identi~ation, glu-
ing street and n:imber if known) :....t3~"._ ivE corner of Lot 3~b, th. W.176 ft., th.
:i0. `.~`~.,~' to F'%,~J~~ t~iE~Ct:;~ llOr±}l2aStPXI.}r on rail~aay~ las;.J's tdl• ~v^
;~ t=et to point of i~c~~-ins~inc~, less Fast 7' for ~. S. ,~1, of ~`aravilla
~~~`~~r~iE~ns- ~'-j~;-..cis r~er p1at...tYie-reo~f --a~:t~-f-i`1-~-.i.ri..~'~~t":~c~~._...~.~~~..~„j...~t.
ruar~eb tio~snty, Flor.i:ia. .. _w~?C;P~Ni S.~y~~~Fja"k---~---
owne y ...................................................- °..... ...
(Alarrte of owner against whose interest lien is cleimed )
fee ~ ~, IT,iI7l f'
L;nose Interest in such real property is...._ ......................................................_........__...-......_.................
(State own.er's interest, as fee si»tple, life es#ate, le:ase-ha1d, if kr~or~vr~ )
Irr~xx f }
Ne further says that the last item of ~ wasj ~ . } an th~......1~_x~.*............
materials tt !urneshed J
dQ~• oJ.....-..-..r''`'.`~'.~~t ............................., 13...."_ and, of the contract price stated, thefe is unpaid
the aryivur.t cf.......-~.`;.? l...s.F.~.-a._„,_
(~3iQie E~F7iUil ilt L;:?i~a1d)
~Or IGfitCh C~t710t!?it hC et!iii'?tS a l!E'3i tJT3 t~e renal ~f!?~[Ert~'f ijSrf"ir<..C,~f.;i "'L(~CL.
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