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CLAIM OF LIBN ' ~
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STATE OF R~
~ p. .
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COUNTY OF . ~,,V C,\E : _ ~
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Before me, the undersiqned authority, ~ersonally appeared ;
~~c~~-~ CRRo.a 'i , who, being duly sworn, says s
(name of lienor.) ~
1
that he is the (lienor herein) (the agent-attorney of the~lienor ;
!
herein) whose address is ~O\ ~,p~i3w~flS ~v . ~t-•~~~'<< ~
~
o h v.tw ` •
and that in pursuance of a contract with ~ ~
t\ (name of purchaser)
~JOOpc-ot~ , lienor furnished labor, services or materials
consisting of ~~.NER~. ~v~~v~N~ ~'t~(L~~~S ; on the fol- ;
(description of materials)
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lowing described real property in ~T . 1~vc.~E. Count , '
Y
(name of county)
Florida; owned by ~ot'~~1`l ~0o4~,oc.~ ; of a total
~ (name of owner)
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~
F
( value of $ ~~Z..~ - ; of which there remains unpaid r
~ (value of material)
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~ $ ~ Z.~C • 00 ; and, furnished the first of the same
£ (unpaid balance)
~ on S~~E^^BE ~ ~ 19 `
~ , , and the last of the same `
~ (date material first furnished) {
~ ~ t
~ on Q cTOQE,~ Z• , 19 ~y , ana (if the lien
~ (date material last furnished) ~
~
- is claimed by one not in privity with the owner) that the lienor
~
n
~ served his no~i ~e t~o~~ o ner on 'T 19 1~
~~~`f"`' ~ (date notice to owner served) ,
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FIlEO AND REC RD ~
~ bY • sT' aoc~a
~o
Ta~i?i~
~ ~ CIERK Ct~CU1T COURT ~
~ Swo o and..s.ypscribed before me RECORD vER~~1ED~
~ ~ s:~~••G:.~c~; - y ?,y Il ~e AN'T5
~ this .••ga ; b~ , 19/ e~. ~
~
f~rtifl~ ~Y• ~
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~ ~~L~ . _ ~ic ~
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My rr0n~~~~TT••~is~i~i es i V w O D s~ / ~ f/
~ , tiV~ 0 R
~ . ~5 PA
~ BOOK
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