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FLA. 1067 LAW ~ IIAMCO FOAM 1 s0 r i
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Before nl~, the urlder:i~rled authority, Personally- appeared ..............~N/EG.. ~i4f3Eli4.................. .
who. beirl~ duly sworn, soya that he is the lienor herein or # ~ ~ of the lienor herein, t
,Da~vs.~ /~2/C K INC
(u.no<s Name) ~ ?
whoa. addreu is~ ..............~oo1.....-----....5~......~/''~ 5 T /YiALE/~i~/1:
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(lierlor's Addreu)
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and that in pursuance of a aontrad wlth
lienor famished labor, services or materials consisting of: (Describe specially fabricated materials separately)
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of a total value of...._ ~~}~..~~~~`.~.---.~f(.ddlars (s _ 308.8
of which there remains unpaid s..- ~Sg Bo for which amount he claims a lien on the fdbwing
described real property in S-r-...-~.(JC .1.. C. _ _ _County, Florida:
(Describe real property wfficiently for identification, including street and number iF krwwn)
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g owned by ................SovT-r-1 c,.Art_[~. __...CORPoRA~T1_o ?~1..........._....... -
Fle further says that lienor famished the first of said labor, services or materials on_...q9 .
Z ~ 19~, and the last of the same on ~ 1~-.t-., and (if the lien
a is claimed by one not in privity with the owner) that the (ienor served his notice to owner on .
- (Method of Service)
By. .
Agent or Attorney
Sworn t4~s~deu6igl~,id:}>•fore nle this ........day of _ ......tg/.
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