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ru? »n wccwuucs• RAMCO FORM 120tiS }
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Before me, the undersigned authority. personally appeared . -
who, being duly swo ,says that hs is the lien herein a the agent of the lienor herein.....
(Lienor's Nsme '
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whose addressis...~Q.SP-.~....~.~"•-~I...4Zr1/."5~........ ,e~n!.....~
- (Lienor's Address) 3
and that in pursuance of a contract wi C~~!~s....~~e
lienor iumished labor, services or materials consisting of: (Descri specially fabricated materials separately)
- ~ -
on the following described real property in County, Florida:
(Describe real property sufficiently for identification, including street and number. if known)
,eta-~ - ~~C ~l.T
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~.rn.~ia~ ~fe-~ ~ .~i S.e~. ~7~ 7~3~0 , ~ ~f /
~,Q~~~f~~ 4g~ 3C
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owned b . ~ . . ~ • ~.Z.~9........... `~'4n.
y.
o~.~t~c ~~~%r~~-f ~ollarslS.. vim" a ~ 4......)
of a total value Q' ~
of which there remains unpaid 5........~~ 6 ~lo..U for which amount he claims a lien on the above
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described real property. '
~ He further says that lienor famished the first of said labor, servic or materials on
f.. f ,191.-7.., and (if the lien
,19.~(~.., and the last of the same on.. -
E is claimed by one not in privity with the owner) that the lienor served his notice to owner on
..............,19 . by_.. ,
(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 . ~ .f . 7 .
-
(Contract/~1~~~~ •
on-------- ......1-g ....1~~..7-~~
....................19..........,by... -f' ,lvL
~ (Method of Service) ~
and additionally, (if the lien is daimsd by~~o}}ne notAin~pfriCv~ity with the bcontra 1 that the lienor served a copy
of his notice to owner on i~~i~...... ~S J.~.... l...l , d.~..
(Subcontractor)
~~S
on
.....................................19..-......., by......._...............-................................................... .
1919 OCt - ~ Pw~ ~2= Zv (Method of ice) ,1
i FiLE01~N0 REC080EU ..~ii/.!"ll. .
S~LUCIE COIINTY.FLA. - •
CLERK CIRCUFT
CO ST Lienor
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RECORD vE?~+ ;E. - - Br
Agent ~4:~{ :~t
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Sworn to and subscribed before ms this_.__.._.-..--•_---L_.-.._-----.-day of ....,.~f`.. t~.~~ ; i
Notary Publ. . a:~,~#;'~'*"~'~
This Inslrtrntrref prrparpd 6y: ASK a N -
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