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FLA. IoS7 LAWS 11AMC0IORM ItOr
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FS 717.09
~l~tYtt ~t~1T
o4~tts of ~Iori~ ~ .
~Iout~ of St Luc ie ~
Before ms, ths undersi9ned authority, personally appeared . S.~amuel D Steele
who, bein9 duly sworn, says Ihat he is the (ienor herein or #~he agent ~ o( the lienor herein,
Ihe altorney
EXC~~...K~..tC.~4115....I7t~.G . _ _ . .
(lienor's Name) .
whose address is ..21?rQ_.O.ld. Dixie....Highway, Fort Pierce, ~Florida. 33450 ,
(Lienor s Addross)
and thaf in purwance of a confrad with W~.~.~~.~. C~.AV~r E~st ..Cqast Self
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Help. Housing . i
lienor fumished labor, services or ma~erials consisling of: (Describe specially fabricated materials separately) I
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1 Set Custom Mi.ca Kitchen Cabinets W/Tops
~ 1 Vanity W/Top }
~ Florida Sales Tax - 49b
Installation Cabinets & Vanity. ,
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oF a total value of EightHundredTwentyTwo & 12/100 dotla~s (S 822 • 12 ) I
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of which there rema~ns unpaid S 822 • 12 , for which amount he daims a lien on the following
desaibed reaf property in St Luc ie County, Flonda:
(Describe real prope~ty suEficiently for identification, induding streel and number if known)
" - . ~CCF=._EG
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~ Sunl and G ardens ~ ~ = ~
Lot 22 glk 26 4~9859
i 3806 Avenue M R :
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~ Wil.lie. Clover
Owned by -
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° He furthe~ says that (ienor furnished ihe first of said labor, services or materials on
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~ 1liost2mher.....7.,..._1.97~._ and the last oF the same on ....No.vem.be]C 8.._ , 19 78, and ~if the lien
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" is daimed by one no1 in privity with the owner~ Ihat Ihe I~enor served his notice to owner on
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~ ~Tovemb.er...9 1978 , by United States Postal Service '
~ (Metnod o4 Service)
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~ ExceL Ki.tchens Inc
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~ Lienor
S By r~ct"-ryY~..~ _ _
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5 AyeM or Attorney ;
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~ Sworn to and subsrnbsd beforo ms Ihis......Eif.th .......day of J anu~ucy .,.,,•'..19 79!'•.' =
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F - • . Cl~~: :
~ Notary Public ~ • = -
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Md?AR~? MLtC STATE Cf fL+OR10"1? /IT•tN~'
~ MY GQAAMISSIQI'1 E7~~R~ F~~, 1952 ~~i
%%ic /~~rlmmr•ul frr~~a~rr;/ S amuel D Steele ~p a~. ~ky~~~'`
,~,/,/„_t, P O Box 1296 ~
: Fort Pierce, F'lorida 33450 ~'`yU~ ~ ~
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