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FLA. tY6~ LAWS 11AMC0IOIIM 1=O•
Fs 717.Oa
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~3tats of ~lari~c ~
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B~for~ m~, th~ undsrsi9n~d suthorify, P~rsonally appeared A ~Z 20~''~~
who, b~in~ duly sworn, say: that hs is tM (ienor heroin or ~~~~9°~~ # oF the lienor herein,
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.1..~.GZ«n..!..!~............~.P~/Fie i,~...1.~~...~.,~-.n~.. _ . . . _
CJ (G~nor s Name)
~-~..SE %J~~?..: e.... ~~,uy - p a. b~x a~ y~ ST.~ K%, ~IA, ,
whose address is....~.........
(lienoi s Address)
and that in pu~suanos of a contrad wifh ~~1~ A A...~.Qn..!.~..._.~. .A...ss.sa.~~
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(o8g Sc ~e AIU ,~~e. . s,. ~u~.e, r~G s/sZ. ,
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(i~nor fumishsd , services or materials consistiny of: (Describe specially fabricated materials s~parafely)
,~.nS~N/~ W~le4 La~c>n SorrF,T
- Lns-}u~~ed ~H~~ 5(~~? So4.F~~
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~u~R Sc-1 s o ~ 4uo~ns
It~~o C>~ eoai s c~G `~i~cc~, ~~I~A~ ~ mc~ctbt<<r ie -(3..~~ c~~~~.
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--~w~~rho..~ ~«.~-lu~•drpd 5 ~r/7 ~
oF a total value oF v?. ylo o a v dollars (s u°" )
of which there remains unpaid S-2 ~lO p , for which amount he claims a lien on the followin9
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s--..I~ l.k jS-,Z, Sr~ j.. Z S" ~ 1-S! ~ S/~u c i~ouni Florida:
desvibed real PropertY in ~ y,
(Desaibe real property wffiae~tly For identificatwn, induding street and number if known)
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i s, 81 3s s~~~ s P~~- 1~OV ? ~i PM'~8
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=iLEG AN~ itEi4ADf~j
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- 422f 99
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Owned by N!~ . t~.n I.Or ~ u v
Hs Fu~ther says that lienor fumished the first of said labor, services or materiais on J~'P~
19..~~and the last of the same on , 19 and (if the lien
.
is daimed by one nd in privity with the owner) that the lienor served his notice to owner on ~'P?-
. ~ cl 19 by ~H/~~,, ~~i / - ,By yi¢ i ~C.
(Method of Service)
Co~n%y P~aX aei~5 ~ ~lit ~
(1 lienor
By ~ _ J
~ •::,.;J nt or Attorney
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: ~wb?t~ ~o .and wbsaibed before ms this . . . . ~ . _ _....day of - . 19
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~ ~ ' ~ d kr ~e~ V11GE 8~ ~ _ u ~ t~X
. BQC,. ~ ~ ~ ~ Notsry Public
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, _ NATAlv r nq K lTATf b R(~IDA R2E
,..~~Ib.~?l.~/r!r~ne~r! rr ~,rr~;~ j~1'- ~ COA4MISSION EXVIRES fES, ?3. tv7?
J SONDED 1HRU GENFRAL ~Nln~A?J~E 1~1(KRWRRER~ '
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