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/LA. IY67 LAWf ~T AAMGO rORM tiOr •
F! 71 J.09
~ll~ttrit ~a~ ~t~tt ~
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~ouedq of St. Lucie ~
Bsfor~ ms, th~ w~d~ni~nsd aulhoritr, Pusonally- appea~sd.....~.~~e... Wr.... C~!pt~?n
who, b~inq duly sworn, says th~t h~ is the liena herein or # oE the lienor herein,
Keller Buildin~..,Products.., of Ft._.. Pierce,_...Inc....._,.._..
(u~«: N~)
whose addreu is..........405.~.....`'?~...R....v.._5.....1--P.:O.}.. Box_..1988.e...~......P~.erce,....Fla.. ~
(lienor s Ad~ess) .
and that in pursuanos oF a confrad with H~-J.:
S. 7.~1C.......aIIC7?Gt=.. .SdMta~d...G.....C7C.idl.axld........--.
18SO....Palm. Beach...B1vd..,...Stuar.t.. Fla.. 33.494 _ .
lienor Fumished (abor, servios: or materials oonsistin9 oF:. (Descn~e specially Fabricated materials separateiy)
fItEO AA~ REC Rp~o
ST.IUCI~ ^OUM
126 Square Yards Aigh Rise Carpet RoC~~ ~oR~
F~ L
126 SQUd~@ Y8rd8 3~8 Pad ` . RfC09C YER.FiED ~URT
Znstallation ~
~ 3I IO 34 AM'15
3'~'p~'l8
of a total value oF.._-..Six Htu~clred. Nit~e & 3..3/100~QQC~QOC}C..~~an (s 609/33 . ~ ~
of which there ~emains unpaid S 6Q~.R 33 for whid~ amount he daims a lien on the foNowi~g ;
desaibed ~eal Prope~Y i~ _ ..._....~.t..... IauCie..__ . _ County, Florida: ~
(Describe real prope~ty sufficiently for identification, induding street and number if known)
Lot 28 Block 139, N. W. Airosa B~vd., Pt. St. Lucie, F1a.
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~ General Deve~opcn~nt Corporation . . . -
~ owned by. . .
~ He further says that lienor Fumished the ~irst of said labor, services or materials on.
~ ..Nov.....ll.~ 19..~4 and the last of the seme on..__........Nov.. ll..--..-.----.-.-. 19..?4 and (iF the lien
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~ is daimed by one not in privity with the owner) that the lienor served his notice to ownar on .
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Nov..._ 12 19.. ~4 by.. . Certified.. Mail_..
~ (Method of Service)
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_ .,_.Ke.ll~r _ Huildinq...Products._ of_._
: ~ Ft. Pierc@, Inc ~
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~ By--...... 1~~-...........~-~ . .
g; ^ Att
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~ Swom to and subscribed befors rn~ this ~..~..-..day of.... .:.LU~............. ...19_,.. ~
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~ ~ • 4. _ . . . „ x _ c F Kr. . , Notary publl~ .
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~ 7%rr~ Ir~s~nii»ri~~ pr~pnr<<! hv~ Kim Simmons - _ . . ;
~ 4051 3. U 3 1, Ft. Pi~r~ = . - ; ,
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