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HomeMy WebLinkAbout0648 ~ F1.A. IYS7 LAWf 5 ~ ~ AA11C0 IORM 1~0• I• 71,.00 ~l~ti'it ~t~1T - - ~ - Mar~~n ~ 6~Fon n», th~ ~si~d ~uthorilr. P~rsonally- app~ar~d..._......._.....N..~_^... . th~ aqent t wiq. bwq duly swor~, says th~t h~ a th~ IiN+or herein or ~ th~ attorn~y { of th~ li~nor herein, ~ ° ~!h ~ P..~...... G . . . (4«wr s Name) wlws~ addr~ss is.........U'~.'.~~!:tt~.......~ y,,,t....~..... Q~.Q. i~..~.... ..~~!N..S~iv~.....~~..~. (lienor s Addr~u) 3~ j A~' S 7 • ~ and that in pursusnoe oE a ooM~ac1 w~th......... ~r ...............~.1. ~^r.0~............. _ . . r...~.~...,....... . . . . _ . _ , W~nor iumishsd labor, sKVio~s or mat~risls oonsistin9 of: (Dssuib~ sp~t+ally fsbncat~d matwials s~psrat~lp) P,~ ~ o w. a~,?~ 4~ ~ 3 a. q S OVh,p~ I• ~,5. ~ I f~EC A1t0 RE~pROEO 3~.lUC1E COUNTy FIA. Clf.~KCC ~CUIT~C URT ~~~+15 ; s.,• -'cP.If1ED Ju~ 6 {1 a0 AN'1~ of a total valw of ~ ~ _ _ _ . ..dollsa (S . . ~3H • 0 9 ~ ~ '~~P. 0 4 . . . , u of which tMre remsins unpaid i~~ ' , for which anwuM he ua~ms a ue~ on rnQr ronowin~ ~5~.- ~ 1~. t t ~C.. . . dASGfibAd fA~ ~O~ffy 11f _ ~OUMy, f~0~: (Dascrib~ re~ ato~ w~~ily ~x ~enl~~~l~s.+!±, ~~r+g st~~et and nwnber if known) ~..~-t' ~ 8 q~ V~.T ti. r~ ~ 4. t /4-T ~ = N~t.~owt R l~L- ~ Z NG Q i~r+ t~.vw~ ~ I ~ ~ ~ ~S1~ - SIv - p0 ~O - Oo0 ~ ~ : o~.d b,?....._.~.~.~a~.~~. . R~ ...l~.~.d~.~.c.~ s~ _ ~,,all . . ~..~.~i~.•~ . , ..a.i~ , " ,1 - Hs t~xthK says tlat lienor hxnished the first of said labor, ssrvices or materials on. ....~Q(~ ~.1... ' 's ~ ................~...5'~.._._............._....., 19~? and the last of the sams on ................N.~.. 19 and (if the (ien ' E is dsimsd by one nd in privity wi~h the ownsr) that the (ienor served his notice to owner on 1~' F r. ~ 1 4 , 19 Z 7 by ..~Z?.~D1 • _ . _ _ _ . . . . _ . . _ _ _ _ . . . " . . ~ Method of Service) ~ ~ ~ ~ j~~ r ~ _ . ~ li~nor . j l~ _ - . " P~ei ~'z . gy N A~em or Anomey ~ . ~ . - ~ . - G ~ c~ . . . ,f'` r S,ricori~'tv ae~! wbsanb~d b~fon m~ tha......... .l.l.:~, .G.._.~4 .......day of _ _ .19 7 - _ i ~ ~:>;r ~t~ , f r. ~ ' : • r i~ ,,r t'~i+'(~ i . ~ ~ . . ? S . , ~ ~c=~~ ~ t-'~ ~ /~'r/ Sr } _ : ~ i.P ~ » ~~3' v ' a.r ~L~LL. J?, r`--~~~=f~"~,~ _ . . . . • No.tary Publ'K _ n s ~ ~ ,:f -r.~~,;,;~~~ ' C ~ ,3•/ -~O ~~~va.i.•v ~:..`a? ;~~t tce.w,.~~-: . ~ i~I/1 ~ L ~ ~ i . I~!!S IIIA/1////f!// f~n~~~~rr~l /~y: /~i~t'l1~xc f P l.li7t `Jtf~ s~ 0.~, ° k 269 6~6 ; BOC!( PACE . . . . . _