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FLA. 1~67 LAW! . ~T wAMC0/011M faOM
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d~on ms, th~ und~ni~d swhorilr. P~rsonaAy~ app~ar~d-.......~:..~.:.........t•I.~EST~,R,V'~.C.T .
who. b~inq e~luly ~rorn, says tha~ h~ is iM IiMOr herein or ~ th~ a9ent ~ oF the li~nor herein, .
th~ attom~y
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(li~r,o( s Name)
wl,ose addreu is-.......1..~C..~.......~-C...~~..s-rE.!2...... RD....... PC..'.l.Z?'_..........s...`T........LL~c.~.E~...-
(Lienor s Addreu)
and ths~ in purwsno~ of a oon~rad wi~h.. ......1'~. ~~_.~..~...........~,.(~.l.~1..5~..T'.Iz.K..c..~..a...9...N
...`.~..'7.3..........N...-...~~.-.......L.AME~n..7.'_...bR..l.V~, PnRT.... 5T•....~-..4l~jt..,..r-~--.. ,
1'i~nor furnished labor, servioss or materials oonsistin9 oF: (~esc~ specially Fabricatsd msterisl: s~pars~~ly)
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oi a total value oF-.[.YJc`.....T~ClIS~4.N.,..7~`.tllt~~EED -~U;L'"~ddlan (i .1~ .~~~5• )
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of which there remains unpaid s.-....~..~-~- , for whid~ amount he daims a lien on the fdbwin9
described rsal property in-_.......S.i _.._1-.~. C.. _ . County, Fbrida:
(Describe real props~ty sufficiently for idemification, i~dudiry slraet and number iF krwwn) ~
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Owned by..._~~-LM . .
Hs f~xther says that lienor fumished the first of said labor, services or materials on t~'.L.~..+C~.U S.T
..............._....._...---.---~.~C.._.....,19~-~ and the last of the same on ....c.CYQ.$.E..~..._...1 19? s, and (if the lien
is daimsd by one no1 in privity with the owner) that the lienor served his notice ~o owner on
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fILEQ L'~•",;~";aFU. c_ Mei of Service
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