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owned by: i-sT a single adul~-l~-l~ 'e~Ee~F' -
N.e+. u+a .da.... of own..
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~ O,w^er's ~~~er~~e ~n the s~te of the ~mprovement N~m~ and ~ddrq~ of fN t~~+p~~ titl~ Iwld~r, if otMr M~n own~r
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The person(s) or firm(s) who will make said improvements undar direct contract(s) islare:
~ _ .lc~e QjFranr_icr_n ~AS Maadnw LaRP-~ Fnct Pierce, fL :
Name and addrtts of contr~ctor s,
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~ _ and_~ny~thers he ma~-hi re ~
~ Name •nd addrtss of contr~cto~
~ The name and address of the surety on the payment of bonds (if any) as provided under Section 84.231 Florida '
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~ Statutes ~s: -NQNE_._ ;
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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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orher documents toncerning said improvement is: _ N~NE
- Copy of Not~ce to Owner as provided in Section 84.061 (2) (b) a Statutes is also to e sent to CITIZENS FEDERAI
3 SAVINGS AND LOAN ASSOCIATION OF ST. IUCIE COUNTY, Fo r lorida. /
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$gMd (OwM? o~ AutIW?i2ld A9Mf)
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Sworn to and subscribed before me th~s_~Lh_ day of
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_ February , t9~_. ' ~ `
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My Com ~ssion @xpires _ -
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~ Notary Public. ~ 1~'. ' • .
S~~re oi flo.~da. ~t 1u9~ ry. i~
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. _ Not~ry Public. Stale o1 florida at Large -
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1975 ~
_ O R f,A~ (Amrti~tion Expires Sept. lb,
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