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Fl0lIOA STAiYTEf OlEW'f FOW M 120y~ J~onrlucWr~d ~ed la wN !y Tw N. i W. Qn~ Co~ao~y
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~'L~ `1s ~ ~ ~ ST. ~UCI~E COUIiTY FIA. '
~la~m oE ~~en RECORD~VE RF EO C~~~T ~ ~
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~tate of.----Fi.o~?~A------------------------------------------- NOY I I 3 ~e PM'11 ~
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QLOUiltp Of----• ST~--LI]CIE..-------•• i~LB~s ~
_ ___.Jacobs_.Air.Conditioning__of._~or~__Pierce,~__Florida______________________________________________
(Name of Lienor)
3311 Oleander._Avenue.,.. Fort_ Pi~~ce:--~lorida.•-•---------•-------------------•-------.._....--•--•---
(Residence o~ Business Add~ess of Lienor)
being duly sworn sa~~s that in pursuance of a contract with :
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Jim Melvin.,.. Architect ' !
(11r'ame of Lienor's Employ~er or person with whom he cont~acted)
PeP~
he { furnuhed the following (Here describe the labor or services pe~fosmed o~
materials
m terial {urnished. Des ribe ~¢eciallk~abricated materials sebarately),-General__Electric Heating
an~ coo~ing system. ~tefrigerati n equipment for 4 walk iii coolers. K~.tchen Hood
and ductwork _ to__exh~u§~ _ or~--~Qo~,_. _~n~~.-~cS
].l~s---i.~~--b~~h~oom~~__h~i~~Qol ice
mak~ers; 2 venting grilles in bar; 4-Polar walk in cooler door latches; walk in
caoler_. door__gaskets =--~i~~~wq~1~__~~Q:~_ d~.~~w~~e~ _ Y~~t ..'~S?__ 4.Xkl&~S~__~~_.4A__~o€i__ 41uCtwoz~k
from rest room vents to roof exhaust fans; louvred grille on kitchen vent on south
end_ of__building-a-- installation__of ._~boY~-•-------------------------------------------------------••------------------------
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' to the L~alue o/__.~$10_ 026.10). Ten Thousand.twenfiy-six and 10/100------------------
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; (State contract price) ~
~ on the f ollouring desc-~ibed real property. ( Describe real propert~, su~iciently f or identi
fication iv-
E That part of the North ~+~~5 feet of Lot l, C~ON`S
€ ing st~eet and number i
f knozun ):~lt&I2~V?.~W~?N_-~,Y.7.t3S--be~~u__US._H3g,~uy~2~}t__#1.,...and_ the_ Old
; Dixie Highway and being in Section 21, Township 34 South, Range 40 East, in St.
; Lucie County,__ Florida,--as _P~~t _ th~x'eof __x'~CO~.d__~n.._Pa.at__Bactk-- 3-,.--~.-~tage- 24, ~
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e of~the public records of St. Lueie County, Florida. -
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% owned 6y_.Harry--Midelis__and__~a~h~r?~g__~.d~l~s,__1i~s_.w~~~_,...~i34~__~!l._ki~.__~I.i.~~~.s.__~.
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(Nume of owner against whose interest [ien is claimed ) single adult
r
n .
~ uhose~ intt~r~~st i?t st~~h ~eal p~operty is___._fee__ simple_ _ :
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~ (State owner's interest, as f e~e sim ple, li/e estate, lease-hold, i
f knoun ) :
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~ lnbo~ r
~ Ht~ /urtitci sa~•s that the last item of se~viccs wasj pPrfo~med l on the__..__.__Sth
~ matcrials ~ /urnished J
4
~ .November______________________~ lg.. 71_~ an~, of the contract price stated, there is unpaid
da~• o/.------- -
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A thr~ aniount oJ~10,026.10~_ Ten__Thousand__~wenty-&_i,~..~~i..~Q/~,OQ-------_-----_------
'y (State amount unpaid j
/oi u~hi~h amount h~• ~laims a li~°n on th~ ~cal propcrty herein describe .
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~ (Sig ture of Lienor}
Subsc~ib~~d and sworn to bc~forf• me this------ llth------ ---~a)' o'--November 19.-------
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; ~ ---1-~=u-1'-~-~----ti= - - -R~-t!
~ :f;~;'~:,, (Notary Public)
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° ~ ' St. Lucie ~lo~
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~1 Conn$us_ n ex uc~c--- - - !Count ~ State ~
. S' ~v p' 9 21 74 1) ~ )
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