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FtORIDA STATUTES tKEW'S FORIr1 M 120Y~ ManvlocNr~d ond Por wN Ey TM M. i W. Drrr CawpVeY
loctionvill~, Fbrida
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. . ~la~m o E ~~en
~ '65 hOti~ I 6 P~~1 3: y 7
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:,T. LUCI~ COUi:T'Y,
7NDIAN RIVER SEPTTC TANK__SERVTCE,__INC.__AND ROOFING SER~~~_~!~_____________
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(Na~rie o/ Lienor)
--P..O..--Box.,1137-~-------------Yexs~_.~~a~h,_._Flarid~.-----------------------------------------._...-----~------------------
(Residence or Business A~idress of Lienor)
b~~ing duly sworn says that in pursuanc.e of a contract with _.y~s__~~~#,~ies~-(-W3~l~~ourne,
_ Rus~o_~-Genera~,--A~~t~lszp~.~_.C.nr.~-y---Pt....~t....I~ucie-P..Q.._Bcaz_.l$$2,_..Fla.-
(Name of Lienor's Enaployer or pcrson with r.uhom he contractedl
per f ormed labor and
~ie { furnished } the following services and (Here describe the labor or serL~iccs performed or
materials
niatcrials furnishcd. Describe specially fabricated mate;ialsseparatelyl_____________________._...__._.__.__.__.._
- -----------~----.21---S_quares__of__Roof.------------~
- ---------------Tar__Paper_,.._Rock,._Asphalt._.G~av~~---~~-QR--------------------------------------------------~-----~-
Labor
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to the ~,alue of_--~-------~~5-7.DQ-----------
(State contract price)
on the f ollowin; described real propert~~. (Describe real prop~rty su ff iciently f or identi ficc~tian, ~it~-
ing street ancl number if known) :.__Lot 2 Block 70- 10~__Palzcita_ Ct. ~
Port St. Lucie
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owned bt'-----------------General..Development..Corp.-------.-----------------------..._
(1Vnme of owner against ruhvse interest lic~n is clainied j
zc~Itnsf~ intE,r~st in such real propejty is----------F-or---Sa1.e~-------------------------------------------------------------~-------
(State oze,~ner's interest, as f ee sirnple, li f e estate, lease-/told, i f known )
labor performed ~
Ile further sa~~s that the last itern of ~ was~~~ on the..~.
•~:.~~~i;::_~.:`...,
.j
materials ~ -
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~l~)'of----.----~~,p~~et------------------------ 19~.5---,and, of the contract price state~l,:th`~re,is t~n,~airl
.
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thc amount of-------------~~-~i7~~JCQ----------------------------~------------------•-----------------•--~-----------:-.~-....~-=-'----.-..--=---
~State ctmount un~iaid~ ~ ~ - , ~
~ N~1A RN~Ft 5CPi IC TA'~;< S~RrJt~F.. (NG
/or t~itic-h amount hc° clair,is a lien on the real ~ropcrt ~ reitt described.
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~ S: ~aatuT f Lie~ror~) ~
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Sttbs~ribf~d nnd sworn to be f ore me tiiis--------' of l~:'y',~':
. ~
(Notnry ~ukh'e')
21c'- ~ _
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,.t~ c at Iax - - -
•.~y,-=
_ My. Co:u;x.i~sior. :;r.t ires b:az. lst~ 1989. ~~StQt(' ~
;1f}~ Comn~ission ex~tres----------------------------~ (<'ount}~)
a~GK 131 ~28