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Home My WebLink About0798 . FLA. 1967 LAWS IIAMCO FORM ~~pr Fi 71~.06 ~l~itl~t ~r~ ~t~rt ~ ~,~s~0 ~ o~'°~ ` } ~ 6sfor~ ms, th~ wed~ni9ned authorify, i~nonally appeared .:.'c.~' who, b~in9 duly swom, says ~hat hs is tks b+~~wt:harskt:r~ri the agent 1t o~ the (ienor heran, . ~ ~e: ~~Sm[veX ` s . . . . _ - ....t1....:~...r.......... J- _......~w. - - . (li~nor s Name) . . ~~1~~~ _J,_-__ - . , _ . _ , M/IlOiO ~Oii IS. ' • ~ ~ ' ' - i ~ °1'f'1 ~t~)~ ..t:: • ~ .4~.'..~ ....:i::.Q.~..... ....i. „ _ . .y . . _ (lienor s Addreu) . , : .IQQt.a....~.. .......w.f"..1.... i ~j~. ' +-1_ ....a L.1 . _i and that in pursuance of a contrad vrth - " . - . - . L~~.«~.:....~....C=2.L::...t.. ~~~'a/i : ~ . . . . . . . _ . . . . . ~ lienor Fumished labor, ssrvioes or malsrials consisting of: (Describa specially fabricaled materials s~parahly) - . ~ ~ ~ , , . , . ~ FILEO »k = ~ ~j ST. iUC?F ,;.rTy Fl#. 11~~ ~G ~.Q: _t -aAG ~ RT CIERK C+ ~ ~~U Rf~~.c(~'r! • . 3 IZ 54 PH'7~1 ~ I oF a total value oF.. ~ ' - - . . ~ _ _ . = ~e~dlars (S . " ~ . _ ~ ~ of w1iKh there remains unpaid s-. a. - for which amount he daims a iien on the ioliowing - CouN Florida: , desvibsd real prop~rtY ~n - . . _ _ . _ . _ ~ . - _ _ Y. : ~ (Deuribe real propsrty wFfiaently for identificalion, induding street and number if icnown) . . _ ~ _ t, . - . _ . - . _ : ; r _ - . . - ,7_ ' . _ - _ - - - ~ . , i_ . : v ~G ^ ' _ . . - "f - ! ! ~ ~ 1 1 . . . , - ~ . , . - - - ' - _ _ _ . y . Fk Further says that lienor fumished thes fi~s~ of said labo?, services or materials on .=:------r- 19.-......., and-tbs iast of the same on 19;'__ and (if the lien n is da"imed by one not in privity with the owner~ that the lienor setved his noiice to owner on . _ . - _ _ . _ , . 19. y- _ _ _ _ _ . _ . . . (Method of Service) - ~ - • - : . _ _ . _ _ . . . . ~ uerw~ , ~ g _ " . . . . . . ' Y ' , _ ~ ~ ~ ~ t , ~'i' ' . , . . ~ . - ~ . . . I ~ ~ .......da of ~:2 .~.G. . . _ . . . .;_...,.~9 . ; - , _ Swom to and subsan'bsd bsfore ms this. y ~ ' . ' ' r ) i ~ _ ~'s i . t 'V : . - . ~ ~ . .~,r~r~,, v - c~ - - ; ; , ~ ' • ~ . _ _..t......._.. . ~ ~:.~it ~ , • ~ -.i'_ ° - ary Pu ~c : ; k .~a. . ~%y~~•~i~~t Nor,ur,uKK:r '.'~~,;%:'ari4[~ ~ . %lru I~r~lrliniriil ~?rr j~rirrJ ~~y: ~t f~'~"•,N~oH ~ ~S ~ bT~lA~•~.. • ~ 3~hlAM ~hs~~ ~DE .'li/~//t:cc ~MRtTtR! b00K~~ PAG~ 770 _ F - - : G"'%..x"c~'' °,xr~'~.~f,:'.' ~a ~a~+~~:: _ _ _ 3 ~,,,~e. ~ ~,y,. ~ ~t`~ 1 - ~ E _ _ ~ : .