HomeMy WebLinkAbout2106 ilOR10A fTAiYTEi 0lEW'f fO~M M 170y~ tlV. 'G~ M•.~locwr~d o~d ~e1• !r TM M. i W. On. G~P~~y
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2680~5
~tate of_._........Flarida--•
~OUlltp Of_.._.St.__.LuCie
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BEFORE ME, the undersi~ned authority, personally appeared ....E~kIBx~.n.Et_.B~1B:fl~lA~~`,
9ec.,,_.Treas.._.of Bandy Lif~htweight Roofir.g and 3upply, Inc. wi,o -
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6ein~ dul~~ sworn, say~s that he is (the lienor herein) (the [agent] [atto~ney) o/ the lieno~ he~ein)
C ndic Ay e Jensen Beach Fla. t
whosc address is __.._..._~~~-----~-------..g._....----t-+------------•-------------------~..._..------------- ,
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and that in pursuance of a contsact wr'th .Van__ Cott,~._ Ferguson__ and_. Croft~._:a. Florida ;
eneral artnersh~ ~
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licnor /urnished labor, seraices or materials consistin~ of ____I~n~~a~.l.ed___Insu~.a~~un_____________ ~
____.._____and__ furni shed_, inaulat ion.
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(Describe specially fabricated materials separately) ?
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on the f ollowing described ~eal p~operty in ___:___Sx..___Luc.ie_,___~.nunLy_,..Elnrida____________________ ;
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' Cot~nt~•, Florida ------------------------3~E---at_taC2~.ed__~4~'__.4~~~cription_:.------------------------------------------ ~
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e (Desc~i6e property sufficiently fo~ identification and ~ive street add~ess if aaailable)
~ , Kenneth I. ~an Cott, Jr. , Harry M. Ferguson, and Carl L. Croft
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~ o/ a total aalue of $ 2~0, 00----------------------, of which there ~emains un paid $--20~:-~~------------- °
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and furnished the first o/ the same on__ July__ 12_________________________________ 19__?3_ and the last of the
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~ samc on ____.___geptember 12 jg?3_ _ and (if the lien is clafined by one not in privity
~ with thc~ owner) that the lienor ser~?ed hu notice to owne~ on_________________________________________ 19________ by."
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~ • • • 3ent First Federal__sayin s_.atia~
~ (hfre descnbe method of se~rnce of not:ce)-------_----------------------------------- - -g- ;..r..~....., 4y
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~ Loan notice by certiPied mail, Sept. 5, 1973i ~~~;w~_..~',~~ ~
~ -----------------------------------------•---------------------•-----------------n~ ~-----htwel t Roof in----a nd~S Z ~ ~y` .
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Lienor v+. , ~L. ~C . ;
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Sworn to and subse~ibed befo~e me this..._.8._.___ _____day of___..___Novem er____ Ig..~,~»~~4,,,,. ;
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~4 Ai~• Conunission expires------------------------------------------ ~ ~pv ICi! ;
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