HomeMy WebLinkAbout2327 nw tl77 MfCNANICS RAMCO FORM 120',
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(t~t~xim ~t~n
mitts of ~tor~:< 1 ~ 53U"70
~ountp of 1
Before me, the undersigned authority, personalty appeared
who, being duly sworn, says that is the lienor herein or the agent of the lienor herein, . .
~J ~ c~ Q~,~rlls_
(lienor s Name) ~
whose address is y ~sr,~~~~~.. ~ _ ; ~ ~r~
,
(lienor's Address)
~1 ~
and that in pursuance of a contract with . ~.5~~' c~h ~ ~
lienor f/urnished labor, services or mater~ial/s consisting of: (Describe specially f~ab~ricated materials sepaprately)
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on the following described real property in County, Florida:
(Describe real property sufficiently for iLdentification, including street and number, ii known)
9A% ff.'s L o ~ ~Orc~~~ ~ f ~D.~c~ c/v~ ~ Uy ~P :.S~F~ 9~i~
~ _
• _
owned by ~ //P/' l /~T 3 ~ D _5 - /C ~rltz° f-~4
of a total value~~ ~ /j- ~ ~ - - dollars IS _ )
j' /
of which there remains unpaid S~ C~ ,for which amount he claims a lien on the above
described real property.
9
He further says that lienor furnished the first of sa- lab ,services or materials on
F y O
/ ~ ~ ~ , 19 ~ / ,and the last of the same on _ . ~ 19~ / ,and (if the lien
is claimed by one not in privity withlQthe owns//r) that the lienor served his notice to owner on
(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 , 19 , by - _ _ _ ,
(Method of Service)
and additionally, (if the lien is claimed by one not in privity with the subcontractor) that the lienor served acopy -
of his notice to owner on ,
(Subcontractor)
on . 19 . by
O ~ etho ervice)
pry L~~ 1 U ~
~ ST. OUEaCn``I•~ r :tip I` Agent -
rte. Cla.. - ~ ~
Sworn to and subscrib d before me hjs da of ~ TG~ ~ 1"/~.+,. 18~
.
` Cam- Ct 1 ' ' ~ ~.~LJI....
Notary Public
A 7~lii.In.arurrr~•nI /?rr•p7?r.•rl l~~•:
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