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BEFORE ME, the undersigned authority, personally appeared
CHARLES HALL who, '
bein~ duly sworn, says that he is (the lienor herein) (
whosc address is ----._Route.707-Rio,-- J~n~~~._~ea~~h,..__k'~or_i.da.._~~4~~-------------------------•--•-------
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and that in pu~suance o/ a cont~act with __._._.~iE~ATCI~L-T11TI1T-------------------------------------------------------
lirnor f urnished labor, seraices or materials consistin~ of
_ _ _ _SEE ATI'ACHED
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(Describe specially /abricated materials separately) ~ `
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on thc followin~~ described real p~opesty in ------St~_.LuCi~----------------------------------------------------------------- '
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; Count~~, Florida .____.Sheraton__Resort_Inn,.. A1A_Hutchinson Isl~nd,___~~~?S~i~__F3~~cx,~,______.
I~ Florida
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; (Dcsc~ibe prope~ty su f/iciently ~o~ identi
f ication and ~iae street address i
f available)
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j otun~~ bl~ -----SHER.ATCN INN---------------------------....------------------------------------------------------------------------------
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~ nf a total value o/ $_._1~ 434. 38___ of which there. remains un¢aid $_1,~ 434._38..__________
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and f urnished the /i~st o/ the same on__... CCtober__.___4,,______________________ ]g74___ and the last o~ the ~
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san:e on ~e~~~?b~x.-----2f-------------------- 19_74--- and (i~ the lien is claimed by one not in privity ;
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~ with thc~ owner) that the lienor served hu not:ce to owner on_________________________________________ 19_______. 6y
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~ (here des~~ibE~ method of service of notice)___________________________________________
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~ President Lienor
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Sr.~;orlt'~lb~'d~G subscr:bed befose me this----~~h.---------daY v/---~~ru~.ar~-•---------------------
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- Donna Y. 1 (Notary Public)
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