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HomeMy WebLinkAbout1276 i qvllOA ~1AiYTtS ptlMl'f fOtM Y IlOS+i tEV. 'N ~ii1~~1DfN ~~«,~~~.~1 ~!IM N~'. a~~ C~~co+Y t~ 0~11~1-IN~ 'm oE "~ien ~ ~ : ~(a< < 286~90 i ~tace ot... ~,~:~,-~~i--• ~ , ~ . ~ ~ ~ ~ountp_ of.._.. . . . , en~ed ..~G.~~_. . ~ ' ed authont e~sonall)' app BF.FORE ATF., t c underngn ) A , l ----7-~•-~?-..._.---•._......._, wlto, .l~l - ..~f7 . - tN- ~ bcing dul~~ swo~n, says that he is (the l' no~ herein) (the [agcntJ [attorney] o/ thf lienor he~e:n) ..~~~dl/-• . - . ~~~~2. _~1_QJ~_ ~Q%~~- ~ whos~ add~ESS is - _ _ _ 2. • -•---._..~l~.d~2.,- ' . . . . . and that in pursuance o~ a contract wit t__ - /~r~~~~ ; _ _ .1.~~.~~~~~`~_-.r~__. - - ~~~y ' . - T - , : . . _ ~ licnor iurnished labo~, se~vi~cs or matcrials consisting o/ - - -•--------------ftt~~_~_:--::E.y~AF~A' - ST. Ll• • JL _ ~ -~l.E.v.~_ : • „GJRT`~ ~9 l. . ~ v ~ O . y.: ~;---$-----3-~8-Q~-'-~~-------- (Describe speciall~~ fabricated materials sFparatc y) . : - - on the following describcd ~ea p~opert} in - : _l_.7_._..~ - _1_~.~---.- - ' _....1~------------- Gounh• Flonda - - - " - ~ r~-`~..~"`- , . -.__.a~°___.___. _ _ - _ : ~ ' tion and iae st~ect address i/ ar;a:la6le) ~ !Descr:be pr ~rt~• su//icientl~~ for tdentzfica ~ _ - - - ~ _ - - - - . owricd b~• - i ' - - - ,(f~L~i -t~ ~ o/ a total aalue of - - of wh:ch there ~ema:ns un patd J- . 6'~ I r~ 19-/-~ and the last o/ the and furnished thc first of the same on_.._.___ _ same on ~I ~l_ 13 and (if the lien is ~laimed 63• one not in p?i:~ity 191 _"1. by < with !he oumPr) that the lienor served his notice to owne~ on.___ _ : s , ~ (herc describr mcthod of se~vice of notice)--•-,.!%~~--~- - • ~ ~ " Lienor - . 19l.~ _da o - - - - : ~ ~ ~ - • Y - ,..~_;ti ` Swo~n t!~ and subscribed be/ore me th:s___.. ~ " : : , - _ : ~ ~y (Nota~y Public) - ~ . ~ ~'•ti : ; .~.1 ~i o. .nr tion c.r~i~es__ . I - . - 3~,i,j ~ ~ - ~,~L~•-a~~. - . • AL• 1 v ' L~= ~ : ~ ~ • ~ ' ~ n~,, ~.'`~~~`,-T BOOK~~ PJH?t ' ~7/'!t• 'f`t~5+ik" , - - - _ - _ ~ :X~ ~ Y ~~:r .~..1