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HomeMy WebLinkAbout0280 ; 11AMC0 FORM 1spM FLA Ip6~ lAW• FS e~.0a1 l~l t~l~ttz~t ~a~ ~lit~n ti ; s~-~~~ ~tats of ~luriDu ~ ~ouid~ of BeFore me, the unde~si9nsd authority. Personally- appeared....-."'.'. _1..:'. ` _ the agent ( ~ who, bein9 duly sworn, says that he is the lierwr herein or ; the attorney (°F the lienor f~erein,_ ~ ~ j,C.l - .7 t - rn~- r i - r ~ .:f . : _ . - - - - . . _ _ _ . _ _ (Lienor's Name) ~rj'?~ •c~~., - ~ ,'C'.~-~~ ~ _f~7C=' ~i'~~-• ~ whose addreu iS_ . _ . . . - (Lienor's Address) . . ~ . , , + • • h _.~:,C'~. ' and thal in purwance of a contrad wifh . ~ . . _ _ . , lienor fumished (abor, services or materials consistiny oF: (Describe spec+ally Fabritated materials separately) _ . , ~ , _ r' . • a- _ ' . . : 1^:.'.- .r- _ . V~ r. ~•~,i ~ . - _ . v.i - - ~ - ' _ ~ , ' ~'C C , `~_l. . ~ ~ . . ~ ' _ - _ Z:,. ' r~~y~~~' . 1 ' ` f.n t ~ ~f ' . " ~ ? , ~ . _ . . . . . - . . ' - . . _ . . of a total value of ` . . ..y ~ 1' 'a r o ~ r , - i. . ~ 1 i' ~ dollars S ^ . • 'L ~ _ 1 ~ . i . . C -i • ~ ~ 1 ~ ( . ~ ~ ~ ~ ~ . - f of wtiich there remains unpaid S.`' ~ , for which amount he daims a lien on the following ! desaibed real property +n . - ~ ~ . ' ' " County, Florida: ; (Describe real property suHiciently for ideNification, induding slreet and n~mber if known) f 1__-- t , ~ ; - : . i , " - ~%a~ ~ .t• i - ~ !7 , ~ . . . . _ - , ~ - ' , - ~ f~L~[: - , ~ ~:_.~~EO ~ ~T. : ,'.,~i4tY ~A. ~ <<< < ~ . ~:x~ f 4r.~' • - J.~._ ~ ~ ~ ~ Fce 11 i ~ ~ o~ ~H'T~ ~ ( - ~ ~ ~ : . :~:~,r.~ . _ _ _ _ _ . . $ Owned by : ~ ~ ~ He furthe~ says that lienor furnished the first of said labor, services or materials on - - ' . . _ . _ ~ , ~a 19-.. _ and the (ast of the same on _ 19 , and (if the lien ~ "-G ~ is daimed by one not in privity with the ownerj that the lienor served his notice to owner on ~ _ _ , _ , . . ~ . _ . 19: by _ _ _ _ (Method of Service) _ _ _ ~ - ~ _ 'eno . ~ ~ . _ . , _ . : ~ ~ ~ By . _ _ - . . Agent or ttorney : Sworn to and~wbscri~ 6efore ms this ........day of / e. .~"t v ~.r. ~j .19 ~ v ~ / ~ ~ !I = • ' - „ ! ~ - ; - . . w _ . ~L ~ i ' • _ _ _ v~.. _ ~s~-;t. y~ t _ _ I - v _J Notary Public r ~ ~ ~ _ . , • ' ' , r_ t F ~ ~ E ~ .~V ~f~`.'..Y.l-^~'.~ .~t r. n S ~ 7 / - / ~ ~ . - _ ~ ~ ~ ~ ~ ~ T : ~ . _ _ _ ~ ~'°~"T: