HomeMy WebLinkAbout0238 _ , ~ . L... ..w ..r..
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t. Lucie i _
. - Norman L. Paxton~ Jr. i ~
BeFors me, the unde~styned au~honty. Pe~sonally appea~ed . . . . . . .
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who, bean9 duly sworn, says thal he is the lienor herain o~ ~ t f~~
a~`~ y~ ~i the lierwr herein, - :
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I~ SAFWAY STEEL SCAFFOLDS C0. OF GEORGIA '
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(lienor s Name) ~
~ . th Street Jacksonville Florida 32206 I
, 221 East 8 _ '
whose atldreu ~s_ . . . _ . . . . . :
i (Lienor's Address)
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and that in pursuance of a contrad with . . . Concrete,...M.o.d.u]..a.r.....5.~ ~ _ems Z.uc... _ _ '
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lienor (um"~shed labor, services ar materials consisting of: (Describe specially fabricated materials saperately)
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i~ Horizontal Shoring equipment rental ~
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i of a total value oF S.even ~housand F~.ve. Hundred and _ dollars (s~ ~554_. 28 _ :
Fifty-four and 28/100 ;
04 which there remains unpaid ~ 7, S 5 4.~ 8 , for which amounf !ie daims a(ien on the following ! -
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desaibed real property in _ S t. Luc i e__ _ Co~nly, F~orida: ~
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~ (Qesuibe real property sufEiciently for identification, induding slreet and number if known) ~
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See attached sheet 1
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Concrete Modular Systems Inc. ;
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He further says lhat lienor fumished the first oF said labor, services or materials on - ~ '
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J u n e 21 19 ~ 4, and (iE fhe lien ~
M a r c h. ..1 . 19.. and the last of the same on , .
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is daimed by one not in privily with the owner) that the lienor served his notice to ov~ner on -
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` 19. by . _ . _ . _ . ;
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(Method oF Service} '
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S~IFWAY STEEL SCAFFOLDS C0. OF '
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Lien
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Agent or Attorney.'~.,~`;~~~! - d`!~?;`~; ~
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, i!_ June.,-?''`~ • .74 ~`:`Y :
Sworn to and subsaibed bef3re me this-...... .......day of . ,r,;_: ..~J..~19 ~~V = -
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li Notary Public S~'~`~~ • p~!
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229 ~AGE Florida at Large ~f~t«<1.
BOOK My Conmission Expires: tS- to-.,•~
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