HomeMy WebLinkAbout2538 ~u? Meew?M~cs~ RAMCO FORM 120Yi
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Bofors me. the undersigned authority. personally appeared ......X..
who. being duly sworn, says that he is tM lienor herein a the agtnt of the lienor herein,
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whose address is ~~.a.....~ r~ Gr'J...~//l.~!../rQ~~... /"...G~:./>,'+~'
(lienor's//Ad''dress) f f
and that in pursuance of a contract with--....~~
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lienor furnished labor, servicd~ or materials consisting of: (Osscribe specially fabricated materials separately)
an the following described real property in v.L.l. ..............County, Florida:
(Describe real property sufficiently for identification, including street and number, if known)
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Lot
owned by..rd~...!~P.~ys~:1
~,YJ ~Z.Da........)
ofstotalvalueof .p~..!.:.~- - - -dollarslS....-~.-•.-~.- - - -
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of which there remains unpaid 5...---- ~ for which amount he claims a lien on the above
described real property.
He~further says that lienor furnished the first of said labor, services or materials on
U , 19..7, and the last of the same on....~. 19~., and (if the lien
is claimed by one not in privity with the owner) that the lienor served his notice too nor on
t
s -
(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)
on...__ _
(Method 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)
_
~
. 1
4!jCv~`' (Method of Service)
L.ienor I,
~ 1
3
By _
Agent
t,,~„..,,, 7...9'
Sworn to and subscribed before me this.-.-...__...-~....._-....._...-........da of ...................19.
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This Insfrum~•nl prrparr~d bv: ~ lta, ~~1~E~ aF$ lea AT lA~r£
fi {SSI~Jt!`iX!!iR(!.S ~u'T. 7, °o~
Addrr•cs
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