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HomeMy WebLinkAbout0355 FlA IB6J LAW• ~ 11AMC0 FORM 120M iS at.0e1 l~1 (~l~tl~t ~af ~~it~ert ~txis af ~lariDx ~ of ~ ( ~ 1 6efore me, the unde~si9ned authority, personally appear ed ` ~ ~ ~ ~ ~ ~ ~ ~ ~ . the a ent ~ ~ ` who, bein9 duly sworn, says that he is the lienor herein or ; oF the I~enor herein, j i _ . . _ . _ _ . ~ . ; _ . . . _ _ _ _ (lienor"s Name) ~ . - . , - . << ~ . whose addreu ~s . _ . : - , - - • • _ (Lienor's Address) f ~ _ . - ~ . ~ - .._.:.-.1' . -i~;:,•? ' and that in pursuance o( a contraci with ` ~ ` ~ ~ ` 1 ~ ` ' ~ - ' ~ ' ` - ~ ' I~ , ' ~ . - . , _~i~. . "i-:r~li: . _:1.-.0 .r~~:-. 3_:~:;:_ ....c: N.._ i~:: i~: i^ , lienor fumished {abor, services or maierials consisting of: (Describe spec~aiiy fab~icated materials separateiy) ' ) ,oi~e-- • ' ~ `1- . . _ ' ~ - , Fi;" RfCdRQEO' - ' S~. iCiCt~ CO:IRTI FLA. kG ;F - P`3:FRAS _ / CLE~.?~ ~~~,CUtT COUBT ~ ~Y acC;~, y~~:FiED ' OEC I 1 4 s2 ~N'T I , ~f i•. i h~~ 'r ~ ; ~ ~ j ~ _ ~ _ . . .~~,a _ • _ ~ ; of a total value oF dollars (S ) i ~ of which there remains unpaid S , for which amount he claims a 1~en on the following ~ ~ desaibed ~ea) property in ' i-''= County, Florida: ~ ~ (Describe real property suFficiently for identification, indudi~g stree~ and number if known} : s ~ . - ~ ~ - ~ - - • • ' : ~ a~ - ~ . ) . . < ~ ~ ~ - _ . . _ U.S.~_ ~ . L.I / ' ?i- -~C- : ~ ~ P ~ Z I ~ I ~ E ~ ~R ~ r ~ I ! ~ ~ ~ ~ . - . ~ ) [ ~ - _ - - } - _ ~ ~ I ~ ~ Ownedby : . _ . . , ~ ~ He further says that lienor (urnished the First of said labar, services or mate~ials on ~ . 19.-~- and the lasl of Ihe same on ~ = , ~9 - = , and (if the lien _ _ ~ ;3 is daimed by one not in priviry with the owner) that the lienor served his noiice to owner on . . , . ~F~°~.1:..... ~q ~ b L. . y ~ - - . , , _ (Method af Service) ~.`S i _ . _ . ~ .Jll l ~ ~ ? ~ ~ . ~ • . - ~.1 flOf 7 - _ : ~ By ~r'a,','"" ' _ - A nt or ~~ta~~ _ ...da ~ - ~ ~ Sworn lo snd wbsaibsd before me this__ ...._1 . . y o~ ~ C 19? 1 ~ ~ 'Y:', ~i:i"~ NL~,~ - ` / / , ^ -'~~~//q^ jI fW ~ CI T.~ ` 1~ / / / / ; /iC :l L -'~-f . • L ! vy'4rY r ~ 1~tr C-•-,.-~,.~:~n f:~res ~tWd 1'~, 1~75 ~ Notary Pub+ic _ - ju*is a An..t., ~ =J,,.,•~. " RoKr ~a~f ~~5