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FI.A. 1Y6~ ~AWi AAMCO F011M ItOM
Fi 71J.Oa
~l~ttzzt ~a~ ~t~n
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~oue~t~ of g
l. Lu ~ r e. ~
B~for~ ms, th~ und~rsi~n~d aulhority. P~rsonaliy appeared ~ 1 io~u .
the agenl
who, b~in~ duly swom, says Ihat M is th~ lienor herein or # # oF the lienor hersin, .
~
_ . _ . . . .
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.~O.zt~..~...R.~t.4..l..c.a,~c:...-~-.!~.~...... _
~ (li~nor s Name) _
s t.~ y. Po B ~X ~ K~ ~ ,
,~?E,~. ~--.~sa . . l ~ . ,
(lierwr's Addreu)
and that in purwanos of a coMrad with ~Yl t•.~ ~'I ~t t~. ~^To.~..~.. o. 14. s,~o iv ,
~ 8.br _ s t" .1~~.~~e~~~.. ~a ~ v e. , pi Si. Lu FlA . 33 vsa,, ,
li~nor fumistisd labdf, serviaes or materials consisting of: (Desuibs specially fabricated materials s~paralely)
~4K prn ~ rcy ~A 6orc ~~c/4~.~y b~.y ~ny .ns-t'~ ~l ih~, S1~~na ~~s
~C.t~A,shQd ~e.xQ~~ do~ l~lq ~ Ro~~eR. Foa F1R~ Ry~F
, bo R- ~L.
o~~~ p~~~~,W~,o~Te~~a~ FuIE' F~0.~ Ro:. rr- O.,e~ (~c~;acM ln'I~~SC GP('~41~vya.~./
4~ pp1~PS. Ca~e pNnl R~~ 1-aboR F x i RAs.
~ ~ ~
h 1%~u~ss~•yc~~A 1/wo f~~v~ v~d . 7 7
of a bla) valus oE~..~.$ `1 dollars (S ~
oF which thero remains unpaid = o~, S.'ya~. - 7.7 , for which amount he daims a(ien on the fdlowiny
described real Props~tY ~n S~. ~ r...l~- Gt . CouMy, Fbrida:
(Desuibe roal property wFFiciently for identiFication, indudiny street and number if knowni _
~~i 3s s~-~~i .~s- P s Nov ~ 3~~ PH'18 .
~ ' r~~_~~ ~N3 accoao~c
~ :1. ~C,ER
P4tTRi5 ~ ~
C~ENR Ct~CU1T ~OURf ' `
~ ~ECOA6 vEit~~iEO
~ Q2.~~~$ ` ~
- ~Gf~( 9l ~'l~C 4 f~! ~/~it/i b~ A S s oL, tiv
- . _ . _ _ _
~ owned by
~ Hs further says that lienor Furnished the First of said (abor, services or materials on O~j/7
~ ^
_ 19........, and the (ast of the same on .......C,..c-I 3... , 197~, a~d (if the (ien ~
~s daimed by one no? in privity with the owner) that ~he lienor served his notice to owner on ~G~ .
~ •
~ .1.. I ..,19 by . ~t~/fi~~~ - ~ t7 R ~ ~
~ (Method of Service)
~ /
~ ~ ~ 1 7.o~u ~,11.~ Sl ~K C~<c~ L•
lienor
~
; By .
~ t or ANorney
y
~ • 7
~ ~
~ .
/ .
~ ~ .~'to and subsaibed before ms this._....... . .....day oF ~ d - 19
• ,
~ ' . "
~ ~ . ' c~ YyiC. CC.~,~
~ ~ ~j~
~ ~ 60~K f~7~ t"•'~•~. ~ ~ Notary Public
~ ' ~ MpTI~RV r"?v~ t~~rc ~n~~np tAk(~
~ ~ •7 ~ ~p~,~µ1SS10N EXPIRES iEd. ?3- ~
` ~ .•I f!!,t ~ll~/lIIN/!'/// ~fr 'ilfr ~'1':
~ I I OpNpED fHRU GENfRAI IN~froANCf UwDERWR
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