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~ot~e OE ~ommen~Qemet~t
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~'„o~rey to be na~ov~t• xo~ g~ ~ 1~ a~ea~nooa to m. t r~a~ ;
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ia ~at soai~ ll' Pr~gs l, P~lic A~ds a~ 8~. L~ai~
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Gaueral dascript~on of tlu impror~a~»ant: w. '
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E COUNTY
Fl.ORDA»•M
! ~ Exte~t af Owncr's ixterast in property: (f
ee simple) other: .w.....---._..~_....._
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' Name and addrt.~s of f
st simpk title holdtr if other than Ount~r:
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f awnersln~ u other thern f
ee nmpk, the riame and addrtu o
f the f
ce simple tisle hotd~r mw# _
. also ba givcn) ~
~ Na»u end addseu af CoHtractos : ...........................~........--..----..---~---S~~soa_.Bro~. j.. ~ ~ . : .
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Nanu a~d addrtu of surety on paymcnt l~ond, if any~ and amount of the bond: : -
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Name ~utd addrsss, withi~ ~Jte Stata of Florida, of a pe~rsoA o~her than the Oumer sign:rig this
. notics, designated by the undersigned to rec~ive service of notices or other documents:
Nanu a~ed addrtu of parson !o ftctive to~ry of Lisno~'s Notice as ~rrovided in Sec. 84.061(2) (8)
; Florids Statistes (Optiona~l): . ..................M..........................~............-•------~-
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