HomeMy WebLinkAbout0320 v
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IIA. 1967 LAWi ; IIAMCO fOqM 120\
FS 71~00
C~l~i~ ~f ~t~n
~tats of ~toriDs ~
~vusd~j of ~j~~ . 1,. c r~
d~For~ ms, th~ und~~si~d a~lwriy, personally appear ~d
who. b~in~ duly sworn, say: thst M is tM Genor h~roin or #~he ageni ~ o( the I~enor he~e~n,
IM attorney ~
. .....................G.hqR.I~..S........ ...~,~~A.t..t......~. ~ ~ ~ . _ . . . . .
(uenor: Nan,.)
whos~ addreu ~ .~~L.~..b..........~..........:~..`,I..t.H ...Sf~ Ff~ ~!!=.~'.~-L.._~I''l, .3_3'1 ~"1`
,
~ (li~nor s Addnu)
and thal in pu?suancs of a ooNrad wi~h . . . Yf~N _ . _ . ,
. . . . . . . . . . . . . . _ ,
INno~ fumishsd labor, ssrvias or materiat: oonsistirp of: (Describ~ specially Fabricated material: separa~ely)
CONS {'~~'G~ID~ TiPAI IL•~P F~:.: :y;
ST `tr,~~ ' 1l't~1 r i. ;
- p~ C, f ~ ~
3 ~ ~ 7 ~3 ~
i ('f~ ~~1
C $~MC7. x. ~ ~=~'t ~t.,~,~t 1
%
oF s total valus of.-~ ..ON,~ . T
f tc c~ sA.v al ,v.~d O v O`. a
~ dollars (S ~ )
oi w~wch ti~ere nmains unpaid c~o.~~ , ior wi~ amount he ciaims a lien on the Followiny -
describsd r~al propaty in _ ~ 1. U G f G CowNy, Florida:
(~esaib~ real prop~rty sufFicie~tly for ideNi~icalion, indudin9 s~reet and numbe~ iF krwwn)
Tcd N~BR F47`t-occ•/~ 33 3y ~I~ 3~.~IL qc S~ ~iy Less N~c~i'1
~~l~~i~~ F G,P/~.a..• G~ 9.Pc KCG Al~ 6X fENc/6~/ .x"~ i th.N.~.pi~ ~i..~J ~[sr ~cc ~
i qN1 ,.~Ifo Fn'c~+~+ CC•~IIL~ c~ .SL~- r~f ~1 P~ snl L. SKJ~ c F f',q~r.,r l /~~i+N s f f dc~
f ~f Mr r/
~ ~ V SEL W .~JItN G'V~
ti yY SiC ~~w/~c 3.+1~.~ ftn~ ~Opr4` ~'L-~~~ S 1'1~c~lsr
3~ n'~..r ~"Y SL-c "?S~I•`(~ Ff %o N/~/ Q~Ly MAiiy ~:-~I~/~v/ L.qf~t:,?/ 2c t~ p 44 ~C' .
.~~I i"~~N 1 7 56 C.. t M .?/k
T~ N~S SfsG1. %l. /~l !~C t~L•~ ~~/H~H! ~~i S.CL. NI 1~•'/.t'LIli/
NE 34 Y. Y~ 7r W S E(. . I~N4 A.Jd 'T l.G 1~ 4a 0~~!
e! 1J)- 13'~v
Owned br . _ 1K.~i~ d . t9/lr- K.s< N . _ . . . _
He Furthe? says thaf lienor fwnishsd the hrst of said labor, services or malerials on U G fi. ~ O
19..7.~[, and the last of the same on ......1`:t/..~~' ~2.. 3.. , 19 ? 1 and (iF the ben
f
t
is daimed by one nd in privity with the owner) ~ha~ ~he lienor served his notice to owner on
.........................3.." j.~.. t9~.7 , by I"1~~ s
(Method oF Service)
~ V~c~~'
.4 ~~L~"" ~'~yZ~~C ;
~enor ~
~
~ B .
y . . . . . t
A9eM or A1tw~ey ~
• ~
~ S~a:n to snd wbsaribsd beFore m~ this ~........_......day oF . . 19
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~ c~j" . ~ ~1 .1..~~~-. . . . ~
Notary Public
~+NerY ?„tJ~c. swa .r na•:ea w to.0.
µf C+n~nwwn Enp:r~s Apr~ 1. 19Y0 ~
%lrr; laUnin~r~ul ~?n`km~l l~Y~ d001I+~7 PACE ~ ,'"d'~ y/1~+r~o.. rin ~ bwoip~ ti~
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