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~l~~m of lien
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-~ ,......... .~.~.. - .. (Na»re of Lienor) '
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- ~ `- ~ - ~~~...~x.:lasks:t..l1x~YlLl~a..i•'~~~..~~e~~'~s...Flori~?~----------------------
~~ ,/(y~~ - . , (Residence or Bu,~nesi Address of Lieno
'~:b~n~duly, ruLorn says that in pur.~uance of a contract unth ..--~~~.-~.~~`'-~~••~-~~=a~Y-•--•~---•-•--•------
..,.~~ "~ Ai. ort Read Fort Fierce, Florida
(IVarrre of Lienor's ,~;mployer or person urith whom he contrarted )
labor and
he ~ pe~,~~nzed ~ the following std; (Mere describe the labor or services performed ar
f urnuhed J ma#~ri~
materials furnished. describe specially fabricated materials separately) ..do.s-----•---------------•--••-•-
Gravel stop; eaves drip; a::d flashing-•-•------•---------- -- . ........................
....
......---•-----------•-----... ~t3L7
----------------------------~i~Fo -~~a~~€Ea~.~-o--------........
_~n~.. 3~1.~~~----------------------~...........----------..............--....
to the value of .............•_-.x.~3,.;~.t~t-nns..ar'~ . 1~~contract price)
on the f ollnwing described real property. (Describe real property suff ieiently f or identiJicatian, giv-
. ~ "'hits City-Methodist Church, bida~ay Road, --...
- . ......
ing s.reet ona number :f n~wn ....................•----...
'yL'hite Gity Section cf Fcrt i'3eree, ~'lnri~ ................................................
Darned h ~ `t~iate City ~~Ietk;odis ; C3-,usah .........................................................
y--------------------....._. .
(Name o f Darner against whose interest lien is claimed )
wh;rse interest in silch real property ts.......--...._ ........................_.............-... -- --
(.Sta#e owner's interest, Las fL:e sirn~+le, life estate, lease-hold, if krtowrt)
1(abor ar:d ~ per~r~r?ed
Fie further says that the Last item of weal fursttsired on thE..t~:ect.~.,,h....---...-
r;~tatenars
d(~y nf _....-,~.J' ......................................., i9-~L... and, of tF~c contract prig. sta#e~d, there is lanb(Ird
th:' c:rrtvunt o].....~~--ka'~c~"~w..a.~.od..d~~~..Q.ti`.~...-_i,~i5~., ....................
(SFcax~' amount sin paid )
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