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~l~im oE ~ien ~Il.EO ANQ RE :
sY. ~~uci~ co~~ _
Florida P .~nRt! VF, 1F1
~tat~ ot ~~c. 152426
~'.ount~ oE.._._......~n~ .~u~~Q '6T f EB I PN ~1: 5~ ~
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~tes.,..'~rig_ht . ~ .
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(Name of Lienor) ROGER e•OITRtiS
CLERK CIRCUIT COURT
---------------•--------......-----....._..-----....._...iSQ~----~lxen.u.e.---~-------------.......-----._.......---•-----•--......._............_..._..... `
(Residence o~ Business Address of Lienor)
being duly sworn says that in pu~suance of a contract with :
~
lydia Bell Daxlcins ~
;
,
(Name o
f Lienm's Employe~ or person with whom he contracted ) i
labor and ~
he ~ the f
ollowing (He~e describe the labor or services perf
ormed or '
{ f
urnuhed } materials
materials f
urnuhed. Descrebe specially f
abricated materials sepa~ately) __._.tia~srial_.~urnisb.+~si.s.
__Paint~.._.Wooden doors~...door_ locks_ and_.~rir~~4K..~].~t~~-----------------•---._........----------•-------.._....... ~
Labor was performed in the.hangir.g_ of_ the doors and_puttin,g_locks _on the doors1__.
installed ~la~s .in ~ wir.dows ar.d painted_house int~rior ar.d exterior.
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to the value of---------------•----..F.a~ur.-hur,~tz:ed---=l'~enty~..Fiue.-----~-.~25.~Q ,
(State contract price) , ~ ,
3
on the f
ollowing described seal p~ope~ty. (Describe real prope~ty su~iciently f
o~ identification, giv- ~
~
ing street and numbe~ if knoum) ~
,
~ '
~ , ~
j
~ ------------------------------s~_?5.~~_
o~_ ~.?~~~~__Q~_ i~t_.~Q-----------------•--...__._..__._..__. '
~f
i £
Sl_D--------...------------------------------._...----- 1
. ;
owned bY--------------------------------------- B_e_ll--- ~??_~i?~~_........._._...•---------•------------------------------------------ :
~ (Name of owne~ against whose interest lien u clai»ied)
whose inte~est in such real property u---------------•------------•-----._...._..-----------.__._..---------------------------------------
(State owner's interest, as f ee simple, li
f
e estate, lease-hold, i
f known )
labor
He fu~ther says that the last item of ~ w~~ perfo»ned ~ on the__._.__L.~~_____________ ;
~ materials f
urnuhed
day of______________,Ianuary_______________.______.._., 19_.67_., and, of the cont~act price stated, there is unpaid ~
,
the amount of------------~Q~x__~w~tr_~1----~~~--~Ji.va.and.i:Q__~an~~_...~~425•QQ1-------•------------------•-- ~
.
(State amount unpaid) F
~
f or which amount he claims a lien an the ~eal prope~ty herein des 'bed. ~
~ -LGvi!':-= -
(Signature of Lienor) ;
Subscnbed and sworn to befo~e me thu_._,/ ~.._..___....day of.~ 19-~-Y ~
~ ----6^- ;
~i"" I . t
:
(Notary Public) ?
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S i t Lu 1e L~+'•~u:~w~~n~~~~~~ b & _
II~iARif PUBIiC. SfATE d F10R~DA d Wt6E rl..------~ `c~~_~-s:._-~..---~*r;~
My Commusion ex~r~uus9t~!~ _ . ~r 21' (County~~`' c;~r--""'-••. ~i '(State) ~
pMp~b tNROw+~ Os~fi~ ~ % i
~~9 `'.--~1aT~,," y•; ~ : .
S i = ~ ' -
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_ ~~'~(,ls~lG V. . ~
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. aoox 164 PACE 1395 , ~ ~
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