HomeMy WebLinkAbout2687 F~, RAMGO F011M t=Oh
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e.for. m., th. und.rsi~d P~~ appes~.d
who, b~in~ duly swom~, sa~n 1ha~ !w is th~ lienor hsrsin or ~ th~ a omey ~ of the lienor I~snin,
~:.I~~...~...Msrr.x,.....i?it~~.~l,......,~.~~.i.a~a....~~~~~..................._.................................................._.............
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whos. sddr.ss is .................45.45.....~~:o~.~.._..s..t_......~IB..s..~....~s1s....~!e8~b,...~..1..Q~4'~d8..............._....._................-.
(l;a,or's Ad~ess)
and that in pursuanos of a aontrod withh..........~5~...~4~tr.~~i4~....Cr.Q*....Q~...~:~:~....k~'i.$~?.._IIIG,~
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S i~batas'o
IiMOr fumished Isbor, servioes or materials oonsistin9 of: (Describe specialy fabricared msteriak s~p~arstelr)
6 0 . 9a ~ ~ : ,F-
/'S~~D /~ouh$ o ~ ~Ca bo~ .
of s to~al vafus of......B1aTen._.Thonaand...Five....H~madr.ed...H~ae~tllan (s...II.,S9Q,.~JQ
oF whid~ thers remains id s.......~?.s~s~..----~• for wlyd~ amount hs daims a lien on the fdbwin~ .
~t. Pferce
desa~ed roal property in.....H3l~~Ai~~....?..........1~~~tr...~nd...s.lib~........~g..t~.~#~~9.......---~~--~~-•CountY. Florida:
(Desuibe real property wf~ideMly for idsntificatwn, indudiny street and number if known)
lsiock A, utit # I in iieaL l~lind anbdi~iaicaa in the g.B I~4
~ o! Plat Book #13 Sectioa 1~,? 35 s,$ 4u S Pags~30
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owr~d by ..............Srio_..t~.amatsac.~iQn...C~a.~....~t...F~......P.~,~rc~-s---.Iaa,~.....----........---.....................................
Fle further says that I+enor fumished the first of said labor, services or materials on.....~l.I.~~f~ :
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19........., and the Isst of the same on ....I~II.SI~t._..._.........._..., 19..._..---, and (if the I~en ,
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is dawnsd by ons nd in prrvdy wdh the owner) that the lienor served his notioe to owner on `
,
19-........, by........................-~---........
(Met oF Service)
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5~1.LE O p v~R~F1E Lienor
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eooK 164 P~~ 2 ~ ~
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