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raw un w,EC~u?N,cs~ AAMCO FORM 120
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Before ms, the undersigned authority. personally appeared -N`~- • • l .~v~h'~ :5- • • • • .
who. being duly sworn, says that hs is the lienor herein a the agent of the lienor herein,
........~~aNh../fir.. J~~~.~,.<~..~.....a~e........,~1.3,~ ......../~/rew~.../J~....T.~~~~s ...~aws~,r.~~r,
(lienor's Name)
whose address is---... ~..71......~~.~..j'~:/.~~~...../..'~v............~'T..f.'.iripc.G.-
(lisno~ s. Address)
and that in pursuanceofacontractwith.l.!..~~!A~.'A...."!~~!.F-~••--••~~{~•-~!•`"~N•-••••-•••••-••-~•••••-r~•~' '
lienor furnished labor, services or materials consisting of: (Describe specially fabricated materials separately) 1
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E t
fo/P»? ~a•,...1~ ~oac~R j~/43 ~ /~7~'Y /~~.C /~6~'G~'S /¢n-~ ~ ~j~1~
~C/G/~ CO .................Coup Florida: -
on the following described real property in ty.
(Describe real property sufficiently for identification, including street and number, if known)
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Pp R ~ s r- u~~~-, fIr A. -
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owned by.........I~..~~'.!]......I..:....lT!!:V.....`-.~/1'!~ ~........~/T-.1,.~;f~?----...... •
i
O C~ C~
T ~-..dollars (S O .
of a total value of ~-.~-.....~~~.L~.`!../a/1i~--..../~p.~.~!.A.R..~..'.-----... _ )
Ott ~ rl
of which there remains unpaidS-.-.°~~•----•-••--•-•--~--~--~•~••••--•••----•-••forwhichamount heclaimsalienontheabove ;
described real property.
~ -
~ He further says that lienor furnished the first of said labor, services or materials on '
~ n R~~LC d t
- 7
~ ,19......~-, and the last of the same on.~°. ~...1.j~ ~.'s'•%-- .19.........., and (if the lien
.~H.N~..-.../..y......
is claimed by one not in privity with the owner) that the lienor served his notice to owner on
Y---~• -
~.:..1. ~ ................19.~I.. b
(Method of Service)
and, (if the lien is claimed by one not in privity with the contractor) that the~;lienor served alcopy of his~njoticecto
owner on ""~.Y.....-.../..'.!/.~.~.~%..~........~4!.l..~~.---~~/ti/L. . ~ ~~1 ~L//L/.~~k..l.
. . (Contractor)
i
on...~n.~.....~..~ .................................................797.~.,by....---...~.~1.................-~
(Method of Service)
and additionally, (i? the lien is claimed by one not in privity with the wbcontractor) that the lienor served a,o~- i
-r. •,a...
of his notice to owner on ~ ~ ~ V•'• -
(Subcontractor) ~
-
~ ' .
LL 19......... by
_ on _ .............~VS~~........-.-..-........ `Method of Se~fti~ej+L- ~ _
~ ~ ~ - .senor -
ey.~
S RQ!iCR
FCI i RAS~
Agent '
C! ERit CiRCtilT C~ • i
x
Sworn to and subscrib+b~b~~ote ~?/1~his--_:_ - ..............day of V.. -19~ .
,G~ /
.4 ....~1'1.1Cr1C. . - .
Notary Public `
1•Iri. Irrslnrnt~•~rl Irrr•pnrr•~l b_t-: NOTIFY MNtK A Gf . AT 1'
" Idrlr~•x. ,,.yl(~ 11~ GOMM?SS?OM EICMYf iflrAt. A 1fN~ i
ilOr~~ TMII CBis<K IIiS . ~IfIf1Y
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