HomeMy WebLinkAbout1047 43'7dU'~ ~ /
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L_j:~:re_; ~e ':~~~'.eT,~; '
B~for~ ms, th~ und~rsi9n~d authorily. Personally appeared.._._. _ '
the ayent ~
who, bsin~ duly sworn, says that M is the lieno~ herein or oi the lienor herein, ~
the attorney '
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~~`~~'1:~11'_'Q .;~'1~'~ 'Pr"?i.t~T~ :J@I~~'? ..'.e
. . . _ . ;
(lienor s Name)
,
. .t~ ~ _'..~x 51`~F pierce, ~1-. :~'r:~~ '
whose addreu ~s _ . . ~ . _ _ _ . _ _ _ . , :
(lienor's Addreu)
. '"re~:st:re :;~~~st ~uilder_> I:ic ~
and that in purwance of a confraci wdh. _ . _ . . . _ ,
?~1 P. _ .i. ~'lvd p~rt Lti°ie = 1•:. ~?!~5,~
_ _ ,
li~nor fumished labor, servioes or matsrials consisting of: (Describe specially fabrica~ed materials separately)
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`•n;~ _il";i~'n:a _ ~ J.i r
of a btal va{ue oE. - . - dollars (s j ~ ' ? ` )
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of which there remains unpaid S , for which amount he daims a lien on the following
_~7T'i; .~t :.t1." i.?
described real PropertY i~ _ _ _ County, Florida:
(Describe rea) property suffiaently for identification, induding street and number if known)
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' 3ection 18 Lot 28 Block 787 ~
~ Permit No: 6286 ~
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.".'~f ~ : 50
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~ =~•e- ,~:re , _ ~ ~ _.:i~lde~ ~ ' . '
Owned by . . . . _ _ _ _
~
~ He Further says that lienor furnished the First of. said labor, serv~ces or materials on '
~ _
y 19-........, and the last oF the same on
% 1- ^ l l- ~ ~ 19? ~ , and (if the lien
x.
` is daimed by one not in privity with the owner) that the lienor served his notice to owner on `
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s (Method of Service) -
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~ Lienor
_ By
' Agent or Attorney
. ......day oF ~77~Ca 19 ~ F
; Swom to and subsaibsd befors ms this , ~ ~
~ .~~•:ti.~~~, . . ~f ~ `~i'~2'~~..
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~ ~ ' ~ ' ~ r L+~Q-.~
~ ~ ~ " ~ y Notary Public `t~,
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~ ' • ~ ~ • I. NprNtr 9u.U~ S~~~t ~w~~:,~? ~i t~iE~
l l~t~ /~iJr,-in~~ nl ~~n ~~~rrr,l 1' r: ~ G:; MY GOIMN~:SSION F~JtRfS DEC . i 198?
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