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Owned by: ~~a >
~ Nun~ ~nd• re~s of ownN ~jSS. 02532 ~
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C«ne. s~me.esr ~n the s~re of rhe ,mpro~emem Nam~ and ~ddr~ss of f~~ sin+plt tiH~ hotder, if otMr fhan owr»~ 3
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E The person(s) or f~rm(s) who wi~l make said improvements under dirett contract(s) is; are:
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~ 13~me and ~ddre~s of conrr~aa
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~ and-any--athers -the~--aaa; h i re
N~me and ~ddrys Of contr~aw
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# The name and address of the surety on the payment of bonds (if any) as provided unde? Section 84.231 Florida
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~ Statutes is: _ _ _ ~~,j~ _
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- - _ - _ and the amount of such bond is S . _
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~ The name and address of the owner's authorized agent with this State (if any) on whom may be served notices or ~
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; other documents Concerning said improvement is: _ _ _
' Copy of Not~ce to Owner as provided in Sectio~ 84.061 (2) (b) Florida Statutes is also to be sent to CITIZENS FEDERAL
SAVINGS AND IOAN AaSOCIATION OF ST_ t~JCIE COUNTY, Fort ~ rc rida.
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- Spn~d iOw~+~r or Authoriied A~te+t)
Swom to and subscribed before me th~s_~~ day of ~
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My Commis ires - _ ~ •i~•' , , ~
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t Norary Pubhc, a. t:
~ St~~e of fiond~. at l ry ~~K, 'Y ~ R n(~
Not~ry St~te o} Flo~id~ at Larqe 80~K ~V~7 FACf
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_ 1 Ay Commission E,cpires t 16, 1975
b•I.d h Aw«K~n fn ~ G.u~ Co.
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