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BEFORE ME, -the unde~segned authority, personally appeared
S. Maxine Bessemer who,
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being duly sworn, says that he is (the lienor herein) (the [agent] [attorney] of the lienor herein)
whose address is .............B~i~Y_. I~?~.t~~l~~Q~_I~C.,....-•---.._......_......._......_.._......----......_~...._._......._. .
. ...........:....................••--••----~~3..Candice_.Ave._-. Jensen _Seach,.. Florida..~~457.--........
and that in pu~suance of a contract urith .__....~.....Cc....C~:idl~nd__Conatr~utC#.io~n _
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lieno~ f urnuhed labor, services o~ materials consisting of
Fibe~'S~.~I~A .
Ila~~].~~~0~
~u a~A
aT R~G~E+~.~ UH~~'0 .
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R !!IT
F1iR CJY~
, ECORn VEA;Ftfp ~OUBt ~
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...................:.........................-----------._.._._._._...._.._.__.___...f~„ .
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(Describe specially fabricated materials sepa~ately) 2 32 ~N'r~
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on the f ollounng descnbed ~eal o ert :n S~~__~.17~~1lEE-------------•--....-----------•----------.._......_..--------
AT P y .
, .................................:....'~~~i
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' County, Florida
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~ Lot 20 Block 139...._----------•-------•-
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272 N. K. Airoso Blvd.,
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(Describe prope~ty su
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ficiently for :denttf:cnt:on and ~ive street address i
f ava:lab e
owned by --•------~Y1~~~81__Ae~~~p~i~~._ ~oZ'~------------------------------------------------------------------------------• .
180.00 o
f which there ~emains unpaid 180, 00______________
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f a total vatue of ,
and fu~nuhed the first of the same on______________4~~Qh~~_.11~,...___-.----, 19-~4-- and the last o~ the
same on OG~Ab~JC___~~..._______________ 19..7.~l:_ and (if the lien is claimed by one not in privity
with the ownes) that the lienor served his notice to owne~ on..__..__ November _ i!4,~__~ jg.?4 _ by
(he~e describe method of service of notice).._...._~.er_ti1:i~..Ma11
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Lienor
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Sworn to and subscribed before me thu._.__.._..._~~_?_.._day ~f__ ~
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M~~ Commisy~S~1 ~1~s SIAIE~t~~atu:-at-:~?uGE---------• '.a .,~'"ar ~ •
"MY C~~fMiSSlON Ei:P]RcS t;Qi:_ 7. 1976 ~:a`~\~~~;:r•'•:,.~ ~
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