HomeMy WebLinkAbout0907 CLAIM OF LIEN ~ /
~ 36644'7
STATE OF : .
e ~
COUNTY OF ~Q,~ ~ ~JQ/ s
8efore me, the undersiqned authority, personally appeared
- ~ -
, who, being duly sworn, says
(name of lienor)
that he is the (lienor herein) (the aqent-attorney of the lienor
herein) whose address is Q/ ~~,~/Q,~.~Q /P~
and tt~at in pursuance of a contract with ~~~~U.C ~~.1/Z
L6f':C~.3.'~7 8~~'zO (name of purchaser)
, ,
~j~~~, Q.,~. ~o~S u,~'~ , lienor furnished labor, services or materials
. ~ ~
consisting of ; on the fol-
(descript~on of mater' ls)
~ ~
lowinq described real property in E~;L.~/A L_[J t'.t~/ County.
.
(name of county) ~
' Florida; owned by ~
~~/y/~~
~ ; of a total
~ (name of owner) .
~ value of $ ; of which there remains unpaid ,
~ alue of material)
~ ; and, furnished the first of the same
~ $ ~q~f~l7
(unpaid balance)
on ~ , 19~_^, and the last of the same
(date materia first furnished)
on " , 19~_, and (if the lien
(date ma e ial last furnished)
. ~
is claimed by one not in privity with the owner) that the lienor ~
~
~ served his notice to owner on , 19~_,
(date not ce to owner served) '
-n ~ /~7G~~
~ by . ST~IUC
E COUNTY F~A ~
~ fioCER POITRAS
C~E.'.!c C+RCUIT COURT -
~ Sworn to'~ and ~~si~b~cribed before me ''`-°'~~=o -
r.,
this `~~.~~f ~ , 197y. Nltir 18 2 Zo PN'~1
~ ?
i GZ
;~r.fp~vi~ . 36644'7
.
, : _
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My comziiY~s,iR~Q?,+~
~kpires : 3d Not~nr P~. Stste ol HOria. ~t l~
t,tr Wmsaissiv~ fapires Oct. 30, t9$~
1~d.o tr Aw.ec.• r.. a c....tr, c«+o+~•