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HomeMy WebLinkAbout2109 ~ ~tw. ~w• ~w~a . F~ 7t~.0O ~l~xtri~t ~t~~t z~~,~ , . ~ ~ ~i~ ~ ~ aa ~ . . - ~ ~ _ ~ 6sfon n~s, th~ w~d~rsiyned authorih. Personally appea~ed..._.._.._ ' ~ the a9ent t ~ who, bti~g duly sworn, says that he is the lienw herein o~ # the attorney S°F the lienor herein, : _ , - , . - ' . _ . _ . . . . . . ~ , . (lienor s Name) ' f - • - ~ - ~ : ~ _ . . , - t whose adc!~eu a . . (lienor s Address) _ and that in pursuanos of a contrad with . . - - . - - - ~ - , ; ~ _ - _ : , ; - . - - ~ ~ _ _ ~ _ ~ ~ , ~ . . , ; ' _ ' ~ . . . . . . . . . . . . . . . . ~ i . . . . ~ Weno~ furnished labor, servioes or materials consisting of: (Describe specially fabricated materials separately) ~ } . t ~ _ _ . . = - ' - of a total value of......_... . _ dollan (S ~ _ ) ; of which there remains unpaid s~- for which amount he daims a lien on the following m..._... ` ' _ . . _ _ County, Florida: ~ desvibed re~ PropertY ~ . . (pescribe ~aa~ prcperty wfficieMly for idenfification, induding streel and number iF known~ ~ ~ ~ - , - - . - ~ - , : Estfi~ =~Cti~9ED - - - - . - - ~ Si. ~UCI~ :vuKir FLA_ ~ R:.: :iiTR~S ~ CIE.:R i CQURT i ac~~,; ; _ . .i 1 - . ~o~ Ib 9 3a AH'T~! ; ~ ~ . - , _ _ . . .~'~1 ~ o~d _ _ . _ . . , by.... . x He Further says that lienor furnished the First of said labor, services or materials on - - _ _ ' - , 19-~--~----, and the last oF the same on 19 and (if shs lien ` . - S is daimad by one not in privity with the o~ner) that Ihe lieno~ served his nolice to owner on . ~ ~ 19...... by. _ . ~ ~ _ _ ~ (Me~hod of Service) ~ _ ~ ~ - lierwr , ~ ~ - _ - ~ _ - ~ : , 7j • _ . - _ _ . By. _ - _ - _ ~ Agent or Attomey ; _ - ~ ~ f y~ Swom to and subsm'bsd befors ms tbis--~--- ..............day of - _ 19 ~ ' _ t y ~~y: ~ - ~ T ^ ~ ~ ~'~`"[r~~~r~ryl~~~, 1~ / ' ~ ~ ? ' t ~ . ~ . - . 7 ~ ..'~j ~ + :r^~awaw ~ ~SiF+• ~_~y N~~ ..Rt__~ ` G~/l~2.~ . . ~~~-~-`YL~/. ; .y+ 3J l~R.~~.-1'~i(~ .1 :ai~Y~r•'/;~P' ~j4 ~ . r- . - .,~-t " Notary Public _ " ~ . v . ; : ° 7%ii~ /fislnui~~7N fr~ falrci~ ~1'= _ - ' • _ _ • , _ : , .1JJrr~s \ . • ~ . , , ~ = r . • ' • : 0 R a i ~f.~~ g~x229 ~21~9 ~ _ ~w _ x~ - - - ~ - _ _ . .