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' AMENDED - n k" ~~7
r?~ ron r[cnww~cr RAMCO FORM 120ya
urN ?~w- rs naa
(~l~tim ~t~~t
`~b1•99s
~ x 1
~awdq of St . Luc i e
Betore me, the unde?signsd authority, personally appeared Ga2`y M.... D@Pal_O ~ SY'.•.
who, being duly sworn, says that hs is the lienor herein or the agent of the lienor herein..... ~.SOnkwip.
F~$_ energy...~'1d..E uipment Co, Inc.. d/b/a Coastline Fasteners and
~ g
EQti pme2 ~ GO. ~ IriC . (lienor's Name)
whose address is 7~70...`"w. 42 Street Miami Florida
.
~Lianor's Address)
G.F. Industries
and that in pursuance of a contract with .
lienor furnished labor, services or materials consisting of: (Describe specially fabricated materials separately)
extension cords air compressors screw guns, miscellaneous items
on the following described real property in .$t.-..Luci.e..... County Florida:
(Describe real property sufficiently for identification, including street and number, ii known)
SSE ,9T1i9erf
owned by ~ad,210r-0ceana..,Partnersh~.p _ _ _
One thousand two hundred twenty-
of atotal value of f~,Ve. and...l.2/QOQ. X7CX7C3~X7CXX7C~CXXXXXX-.dollars (S .1,,_2.25.12 1
~I ~ l 22 12 ............,for which amount he claims a lien on the above
j of whic?t there remains unpaid S ..l....-.
i
i described real property.
Ne further says that lienor furnished the first of said labor, services or materials on _
f
Jllly..9.... 19 79 and the fast of the same on July .11..19 ?.•8nd (if the lien
5 is claimed by one not in privity with the owner) that the lienor served his notice to owner on
July 31 79 certified mail
19 ,by _ _ _
R
(Method of Serv'ce1 '
and, (if the lien is claimed by one not in privity with the contractor) that the lienor served a copy of his notice to
s
P
4 owner on
(Contractor)
~ on . 19_ by
(Method of Service)
and additionally, (if the }fen is claimed by one not in privity with the subcontractor) that the lienor served a copy
of his notice to owner on
(Subcontractor)
,19 by _ _ -
on
MASONKWIP FASTEN~S(~cet~~~~~~ CO. ~ Inc
d/b/a COASTLINE FASTENERS & EQIIIPME:VT C0.? Inc
Lie~nyor J'
,1 .
Y
.yti ~ •7 --ant
Sworn to and subscribed before me this $ day of t ~ I„ ~etober ~ 9 79,
Y
%~his Insfrru?tr•?tl ~~r?•par?•d b~-. E7_la BOUtwell - ~ {
,tr~~~r?'ss 7920 East Drive ~~K Ji~