HomeMy WebLinkAbout2005 ru?. un Matw?Mres' RAMCO iORM 1te?4
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- Beioro m., the undersigned authority. personally appeared......~~~.P~.....Ar.A...~..1~.-t~~~.-~.L.1..-.~
who, being duly sworn, says that he is tM lienor herein or the agent of the lienor herein.
• IUenor's Nampme)
whose address is .............~.Q~.1.......~ 1T ~ ~~.-.....C-[- V~..a ,
pp CC ~c(Lierwr's Add/rless)p,~~ t~p~
and that in purswnce of a contract with...~h~ ~.!~~~~.....L.~c~.~ 1~.?.1.........~~-~.[.Rs„]~... ~ .~~x .
lierwi fumishe~ssrvices or materials consistirq of: (Describe specially fabricated materials separately)
It~Sv ta-}-ion -
~wa~ t C ham , s pca~ , h; sh~
on the following described roal property in....~'}..~.... .....County. Florida:
(Describe real property wfficientty for identification, including street and number, if known)
(~rrn; t- rloe 7/qa
W1 Pte. fit, l,u~i~ (3?ud.
owned by.....Q.`.. ~.-..........~.•~..1.Q~'~......~Q.na.~ .
- M -
C '1
of a total value of G..1.Q~~.. hi~(~,.?~.~~5~1.{-'.tJ ~~..~..IQ~dollars lt --.~!'~~..e.l,~ -
of which there remainsVVUnpaid i...`l~.~Q?...la~ for which amount he claims a lien on the above
described real property.
He further says that lienor famished the first of said labor, services or materials on . -
rf[~
k .................19..:.17-. and the last of the same on......-t~..'-...~............-•---- . 19...~, and (if the lien
is claimed by one not in privity with the owner) that the lienor served his notice to owner on..~
..............~o~. -'--I----........, t9..`.1.9.., t?y.........~{i.tY15~1-~..........................-.......-................-........- , -
(Method of Service)
and, (if the lien is claimed by one not in privity with the contractor) that the lienor served a copy of his notice to
owner on -
(Contractor)
lMethod of Service)
and additionally, (if the lien is claimed by one not in privity with the subcontractor) that the lienor served a copy
of his notice to owner on
(Subcontractor)
on ...................sftl:E-D`~R.~~•i`Y.~f,.l:Yp~,----,19....------•by•----------- - .
5S, L~CIE ~
j~R~:: tiED - (Method of Service)
r ~COf~D ~
J _
PN ~ : ZZ lienor
'19 FE8 ,1~
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Sworn to and subs~~sd befori ps.~ar.~.:~.;,..-.`..~ day of .....'~.T~
...................................19.
. Y'• .-i.;4` ~ _ - - otary Public
This /nslruntrnf pr~parPd by; ";.~x'•'V``'
.•.,r•:.:}Yi•`•'-~ NOTA ~eK'trA1ltfFftOttDA T+_~t~,!
Addrr•st r eor~a~ I.~w"y.. t1~ou
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