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ru »n MECMww+cs. RAMCO FORM 120++
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Before me, the undersigned authority, personally eppsared BOb.. • ~ - - - - - - - • • - - • - - • ~ • ~ ~ ~ ~ ~ • ~ ~ • ~ -
who. being duly sworn, says that he is the lienor herein or the agent of the lienor herein.
Hob Banos - ave.. Barn... PZ>m~ving. co.• . .
(Lisnor's Name)
whose address is ~:T.1~!~!~:...~ - ~Et~@ t...~!?4.~~.. ~34~ .
(Lienor's Address)
and that in pursuance of a contract with..$iC~~..I~l~.@T- aba.-~p~l~q..,$.O.atrh..~d8~'S .
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lienor furnished labor, services or materials consisting of: (Describe specially fabricated materials separately)
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1Nirnibor and leaterial for ~jb~Sx jt~ partial
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pluabing of hoaas
on the following described real property in......-....Sgt...r...Ti11C~~ ........................County, Florida:
(Describe real property sufficiently for identification, including street and number, if known? ;
662 3. PortaE's ATeaas
I,ot 11, Hloalc 724, Traat 18 ~
Port St. I,uais, F'lorids
owned by...._..llbmor.-and..Lillian..T+atl99i......._
of a total value of - @i~l't. ht1Y1dT6d. _ @f$~ItY.:
f#,re-.------.------.--..dollars (S~~•~Q........ . _ ) t
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of which there remains unpaid S8$r~-:~-- - - .for which amount he claims a lien on the above
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6 described real property. s
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He further says that lienor furnished the first of said labor, services or materials on
~•9 .15s..... _ , 19_ 7~.., and the last of the same on.... Angti9t. - 2 - - _ . _ • . 19~.~ . _ ,and (if the lien
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is claimed by one not in privity with the owner) that the lienor served his notice to owner on .
..$eptember 24...ts79......by ...»?a~~.
{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
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owner on ~.c~~ .11~~,1@r . dbs•.. ~Oi•R#6 . $G.Lt~I.. H1~li,ldexx~
. (Contractor3
' on 38.p~1~b87'.2Qa.......~......... _....19.7~....by..__f~l•.-... _
(Method of Service)
and additionally, (if the lien is claimed by one not in privity with the subcontractor) that the lienor served a copy
of his notice to owner on _ _ _ _ _ . _ . _ _ . _ _ _ _ .
(Subcontractor)
- ~ ~ 3(3 ~ (Method of Service)
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- i11L;.ri f~~:IY.i~~ ..Plwnbiul~.C.QR.....
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PO1tR~•~' Lienor
' ~ Agent
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Sworn to and Subscribed before me this........... ~ - - .day of IY..C 19
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This lnxfr~~rnr•nt pr~•pnrr~d h.•: BOb Huive ''At~~~ PW~+C STATE OF it.UdIQA AI
Idd~~~~.~ .811 Bearnsq cc,~uw~s.a~, E,c?l~s IYMIt. n f~a~
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