HomeMy WebLinkAbout0800 .4~3a932 ~ - '
~u ~a~ yecw?Mrcs RAMCO f011M 1201~5
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BNo~e m~. th~ undersi~~~d autho~it~?. P~~MIIy sppaar~d . :......1'..:..:.... r
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who. being dut~r swor~. saYs that 1» is the litnor hsr~i~ or ti» s~eot of th~ li~?o~ hKein.
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(U~nor's Nam~) ~
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whos~ add?sss ~s . -~!p( • • •
~ (U~nor's Add~~ss)
andthatinpursusnc~ofacontractwith..... ~ QIl. • • - • • •
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lieoor furnished labor, senices or mate~ials coosistin~ of: (Dsscribe specially fabricated metsrials separately1
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o~ the following dssc~ibed ~sal props?ty in G~~_............................County. florida:
(Oescr be roal propsrty su c~ently for identification, includin~ st~eat and numbar, if known)
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.~u ~ ,f„C~.uO.Cn~ Gc~rt~ ' ~ p ~tj
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owned by . - • . . . . ..~Q-~ J ~
of a total value of ~ ~ -....~/.rl~
.N.Q~.... . ......-•-•....._..l~~~. dollars (S -~-~-f••Q.~
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of which there remains unpaid S•~~- O••••••,•-•••-•.••-.•.• for which amount he ciaims a lien on the above
described real property. ~ ~
, He further says that lienor furnished ths first of said labor, services or materials on . - v- ~ • • - • - • - ~ • • ~ • ~ • •
i .197~. and the last of the same on~/.....~...~-......._... . 79..2 and (if the lien
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~ is claimed by one not in privity with the owne~) that ths lienor served his notice to owner on
~
. ...............19 ~y, by........~.~0~-.. v....... . .
6
~ " (Me of Service)
and, (if the lien is claimed by one not in privity with the contractor) that the lienor served a copq of his notice to
owneron -
(Contractor)
........~19........:., by..........---......- ,
on
~ (Method oi Senrice) ~
and additionelly, (if the lien is clsimed by one not in privity with the subcontractor) that the lienor served a copy
~ of his notice to awner on
~ ~ ISubcontractor) ' ~
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~ BY ~.,.~L.~.,~.::..}1f~ ~+""j'~~~
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Sworn to and subscribed before me this........_...~_.`~._...-~-_-..•-•--•-•day o
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~ _ Notary Public
This tn~tr~unrnt prc~par~d by: K'4K t*~~! cx ~n~rn~ ~ ~ ;
~ ~ ~ss~ ex~tes ~t ~ ty~
Ad~lr.•~.~ ~ P 3UJ 1 t7V ~F~u c~w~t t~mro,r,~ urvoeRwiertfy
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