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~ ti y, i r~~. ~as~ ~~ws ~ ~co ?ow~ ~ao• 29~9z9 ~s s~a.oa . ~ ~l~t'ti~t ~a~ ~'t~rt ~ ~ . - c- / e~For~ m~, fh~ undsrsi9~ed autho~tr. P~rsonall~ sppear~d.........L.......f.::..._.L..~.:.r'.'?.~!.~..:... _ . the ayent who, ban~ dulY swom, says thst b is the lienor heroin or # # of ths lia~or herein, I1! E' C L~lt C C !/V~cSr` / /o ~1P~~i~ ~ .........................~.._.........~.~...............:........---..._............tlienor s Name) ? .v~ C' r~ ~l ~ric~~ ~aa~ s~..:... ~.C~-~ J _ . ~ - ~~;~„~•s ~ - ~ l~" LA![~/G ~ s~d that in pursuanos of a oontrsd with... ....~'l~/~{ _ . . , ja~ - ~loi~id.,~ 3?~07 - r /...lk3~._.... /{r..... ~c~. /c~.v~o c~ ~c!~... _ ~/~~~'dcs . . . . _ c (i~nor fwnished i~or, ssrvioes or materials consis?ing of: (Describe specialh? fab~c~ted mareriak s~p~ara+~?1 . ~ L- ~e ~c ~i~ ir~~~~ b E rr~v,~ ~ riw ~w~~(, ~i~7 f~s- ~ ~ . s sf F a tolal vslue oF~,~•/1?~' ~CN~i~~±c'~ n~.~t b.?,vd.o~! FF,~y ~.4bf~~oNars ~s 1 0 . ~ .r9 of wiiKh thero remains unpaid s~/ '/'z.. for whid~ amour~t he daims a lien on ~~he foNowirg ~'T ! ,v~~ E~. ~ ~ . described real propsrty in . . . . . _ ~Y• flor'da: (Desaibs real propertY wHiaeM~Y for identiFicalion, induding street and nwnber if known) ' ~ .~7~.~~ ~i~ ~ v~c-/t ~ d~ / e ~ . i ~ ; _ I - ~ ~ . o,~a b,?N...~~h. ~ro.,~~ -.Lr~~~~.~ ~.•n. .~.~~u~~P,~f~ _ _ He Further says that lienor fumished ihe First of said labor, services or materials on.. ..J..L.I..,l..~~.~...__. 197~., and the last of the same on i97~and the ~en is daimed by ona rw1 in privity with the owner) Ihat the lienor served his notioe to owner on ~ tIl'Ut>._7:~ t9.7'~ by. .F27`"i ~ : c-_ ~ /~7 i ~ - ~Method of Service~ ~ f - ~'c` T~~,o~4 ~ ~ ~,~IC -/r~ C~1 ~ ~ . ~ ~ ~ . . _ . z,,,~,,., ~ , a~ G~,~ _ _ . gY- _ . r - . , : ` ~ ~ . Agent ar.~IM¦wwyr , t;~,y,~fiMi~J,rt~ir,j,~ . ' • ~ _ -t-~.~-i`~,? _ _.19 7.~ " ;~S~r~~.'l~ga wbsaibsd before m~ tha .................~................_..............day oF . . ' , .:t.~::. ~ , ~ ; . , . _ . _ . .OKs...f . . •r , . • . , . , _ ~ : 4~ : 1~4 ~ a ~ . . . - - - - ~ ~ lat. r: : f`r-.~-._ - HOf Pt~1C _~1 r U- ~ `'t:4i ~ ~ .:+1 y.i~ NOTARY PUBLIC. STAiE d flQAf~l ~f IM6E • YY OOMMfSS10N EXPi[tES JAN. ~ ."~y ~fr• OON~ fNQy CENEA~I i1fS1134trCf U.~;.E~ ~'~p40f~r~qo~~~r'r~ p~r-p~r~-,! !y: ~ d~z ;iqs ~ .;~~id~~rrss~ (~01~ 5~~~ ~/~1iJ~'<<~`/ ~li~. i b d S~~A~ ~~~f ~~1~ ~ - ~Da7 : ~ ; - ~ - ~ s~:~~~ - ~ ~..3~~ . , . - - ~ . . . . ~M ~ ~ Y~~ ~ . -