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7 A •~ry~ iu?wco FoeM 1 ao r
FLA. IN7 LAW t.~'l:~i ~
F• 71s.00
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Seforr msi, Ilre tndarsipt.d authority, persorliUy- aPPearad....John.. F Ladd .
who, being duly :vvor~ says thM he a tFle lierlor herein or ~ ~he~+tte+aey ~ of the lierar herein,
Ft. Pisrce~Utiii~io~,.Authority -
...wW l~~s. Name)
whoN address is .............~....._.pM~.w_.8ox_3191.:...F~.~...P~.l~.~'et.0....F.~.o.~~.~tt~.........~~950...............................
(tierlor's Address)-
snd that in plrsllsnoe of a contrail with Tosl/ a f urnitura Co._.....,......--......... -
herar furnished labor, services a nlat4rials coresistirg oF. (Descn~e specially fabricated materiak separately)
Utilities (ee• attached copy of final bill) .
of a total vslw of.....-•.. Five.._M.~nd.~pd..Th.i.>`ty-f ive...artd...1.8~1.U0......--dollars li 535.18.:. .
535. ~ ~ for which arrlollrlt he claims a lien on the fdlowinp
of whidl then renlairu unpaid s
desarl~ed real property in ................at._..i~u~i.it..................................................-- _ .........County, Florida: _
(Desal~e rest property suffidsntlr for idsrltification, uldudlrlp street and nurrlber if known)
415 Ave A Re-subdivision of receiver subdivision
81ock 1 lot 5
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Tos>a4 Furniture Inc.
Owned by......._....-•-----• - - - .
- Me further says that Gerar fwraslled the First of said labor, services or materials on
.....September 8...._.....,,., 19.69-, and the last of the same on...._august:....2.~ 19..7.7.., and of the Been
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is daimsd by one rwt in privity with the owner) that the lienor served his notice to owner op~.: ~
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(Method of Service) _ r - -
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hn Fradd Agent~rAtterrley •,,,,,?i:,:~,:+t+'''~
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Sworn to and subsarl~ed before nle this / ......1..6....dsy of
Notary Public
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~ f~n~a,a~J 1~~~: Nd?ARr NAIrC stA7! Of FlOt2t0A At LARGE
~ NOIMN11attON EXFlRES !9. 73. 197'
~ ~ 303 1313 _ - UM1~.WRI,ERi
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