HomeMy WebLinkAbout0671 FLA. 1967 LAW8 e"~~j?~s~~ s I~AMGO fORM 1lOM
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Before me, the unclersiQned suthority, rsonall appear J~ n.. ..~~C ~'i" C-
1he agent
who, bein9 duly sworn, says Iha1 he is the lienor heroin or ;~MY ~ of the lienor herein,
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~/'r" G~'d / S 87~ (lierwr s Name)
whose addreu is......:~ .~'~'.........f n.i-n~_r.°s... I~'.fr /i
c/._;. ff .~_~i-c ~<<~• 333/Sv
(lieno~ s Address) ~
and that in pu~suance of a contrad with ,~/7 7`t' :~~.'.t'~'•.c.~.. G.
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lienor fumished labor, services or malerials consisting of: (Describe spec+ally fabritated materials ssparafely) -
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of a total value of.~~. r - f/ n J-Fr ~ ~,c -f~~,~~Ir C ~-/~,~r..>~, -f6~~~ dollan (S ~ ~=~,3• ~ )
of which thare remains unpaid S~ y~.; • C' for which amount he daims a lien on the following
desuibed real Propefi+ in s. G/ e County, Flo~ida:
(Describe real property sufFiaently for identification, induding street and number if known)
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~ He Further says that lienor furnished the first of said labor, services or materials on C y_
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~ 19.7~', and the last of the same on . . . . . , 19 7~, 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 owner on
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~ f1lED ~vt' ~f G~?~~Ed (Method of Service~
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~ Sworn to and subscribed before me this._.. ~ . day of _ ~l{ . ;1~ ~ ~ ;
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~ !%iis L/.~/llll/Jr'Il/ f~n~~r~rr ~ Ii~? ~o~uss~ot+ vc~~RES ~s. 73.'t9'~v . ,
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