HomeMy WebLinkAbout0013 flA 1!)7 MECNAhICL RAMCO FORM 120':
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Betore me, the undersigned authority, personally appeared -S o c kJn 9 1 ~ ~1 d' ~ e r' c
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who, being duly sworn, says that fie ~s the lienor herein or he agent of the lienor herein, _
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J (Lienor's Nalne)
whose address is . IL~G ~ 4 . Vim' (~.f•t o ~~4
_ _ ,
(Lienor's Address) 3 96 0
and that in pursuance of a contract with....../ .
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lienor furnished labor, services or materials consisting of: (Describe soecially fabricated materials separately)
pCvyrre c~ ~ c
r/ ~ -
on the followin described real ro ert in ..~'C.%
C <l`-r
9 P P Y - County, Florida:
(Describe real property sufficiently for identification, including street and number, if known)
owned by ? / Q ~ `J C' T L,-- _ _ _
r . ~j ~J C--
of atotal value of dollars lS -S./..~ ~7 J
of which there remains unpaid S. .J . ~ 7• J^C-- ,for which amount he claims a/ lien on~thef abo/v_e
described real property, lz ~ f!L_`,l~~ ~ ~ •T ~ cc, -~C«'~
He further says that lienor furnished the first of said labor, services or materials on _(_.u~
' ~~q
f , 19_.,/,and the last of the same on. ~.~.1 ~ _ . , 19 < _L.. and (if the lien
.
f is claimed by one not in privity with the owner) that the lienor served his notice to owner on
_ ,t9_ ,by _ . _ _ _ _ _ _ _ _ . ,
€I (Method of Service)
and, lif the lien is claimed by one not in privity with the contractor) that the lienor served a copy of his notice to
F
owner on
I j _ (Contractor)
on_ ,_.~.~~z~?_f - _ _ _ ,197.E .bY
f (Method of Service)
and additionally, lif the lien is claimed by one not in privity with the subcontractor) that the lienor served a copy
a
of his notice to owner on
(Subcontractor)
on ,19 , by _ _ ~ _ .
nn ~ 23 , (Method of Service)
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- ~Swiom to and subscribed before me this J of ~ 19
\ Notary Public
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i :lFlrl rr•x~ NpTARt ltJ1LIC NA111 OF iift~il0iA III ~ - ~
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