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131~:1~012E ?11~:, thc~ tindci•signed authoi•it}•, pf~c~sonall~~ -
appc~arc~d SHIRL.r:1' L.1~', ~t~iic> afit°?• be~~in~ ditl~~ ~«~oi~n statc~ti as
fallo~ti s:
l. '1'he ~ii'fiai~t i~ tii~~ same A~IRS. S~IIRLLI I.AI' ~+~lio
is mc~ntionc~d in the agreE m~~nt that is attached to this Affidavit, ~nd
this a~r~~~~me~nt is hcreb~• incoz•porated into the Affidavit by reference.
'1'tiat c>n Derenlbei• 1S, 1,)69, Affiant stat~s that
5ignatorirs c~n thc~ agi•c~~'rill'i11 inttnciE~d thi, agrc~c~ment to act as a lien
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= c~~i ttiE pc•opc~i•t~~ located at 303Fi SUII1I1111. Street, F'oi•t Piei~ce, Floi•ida.
j Said pro~~t~rt~- 2urthc~c• l~c~ing described as:
Lut 131ock f3, PIO\EEH YARI~ SLTI3DI~- ISION,
= lc~~•ated in St. Luci~ Cotlnt~~, r'lorida.
3. ~t'fiac~t ~tates ttiat there is still outstanding undcr
ttii~ ~~I'E~ertient an ainount of S1, 100.00 plus interest.
: .ltfiant 5tates tt_~t tliis Affidavit is Ueing filed for the
purpo~c~ of ~i~-ii~g prc~~pc~ctivc ~~urrha:~ers of said desct•ibed propert~~,
sufiicic~nt rioticc° that therc~ i:~ lien otit~tanding ta thc ~ffiant's bt~nefit.
I= L. RTHEI~ .lffiant ~a~~eth not,
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S«"(~Ht T(~ :~1I) St-I3SCRI13ED before me this
_ da~ c~i Oc!ohc•r, 1~± ~ 1.
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1~c~ta?~~ub1iC, State of Florida ~ar-
Largc. 11~= Commission Expires:
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1=AUL U BURCH 9 GEORGE G COLLINS JR . ATTORNEYS AT LAW i
- P O BOX 5-?065 15TH AVENUE - VERO BEACH. FLORIDA 3'L960 i
- PHONE 567.3463
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