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45154
FLA. 1Ye7 LAWO ~ 11AMC0 FORM tiOr
Fe 71,.Oe
? ~ i
~i~ttm ~t~n
of Saint Lucie
Before me, the ~ . J--:::~e-~.~.,/
undersigned authority, personaib. appeared
t
who, bsiiig duly sworn, says that he is the lierior herein or ~ theme ~ of the lienor herein,-
...................._............~._...._.....Hanslsr....~unt~].a~icta...~aa........
(Lienor
s Name)
whose address is-...........303..-•CaAdi,ce...A~............ Jensen -Reach,----F1a....334-~~ _
(Lienor s Addreu)
end that in pursuance of a oontrad with-........_P41rtt South•~Hui~der~ ,
......................................_............................................P.o.. Bwc.335 Stuart,..F1a....33494......._.............. ,
lienor furnished labor, services or materials consisting of: (Desuibe specially fabricated materials separately)
Installed Fiberglass Insulation ~
;
of a total value of ...Fi~te...Hundred &-.tsightyFive dollars (s SSO.00Plus 5.00...)
of which there remains unpaid s-- 585.00-- - _ - - for wlwd~ amount he claims a lien on the fdlowing
described real property in..--...Saint...Lueis~---. _ _ County, Florida:
(Describe real property suffiaently for identification, including street and number if known)
Lot 25-Block 52 i i5 ~ 3~
1125 S•g. Cambridge Ave.
Port Saint Lucie, Fla. 33452 ze~ apt: c~~: ~
5 f
GGER
F'G 7fiAS~ -
CLEEt; GtRGUii CC~~'
Hj i. ~l ~Ei
4154
Owned by......-.william--J....Fesh
He Further says that lienor furnished the first of said labor, services or materials on............ _ _ _ _
......•9/27/79.._..._..._....._...., 19........., and the last of the same on ---...--..9~28~7St 19 ,and (if the lien
is da'inisd by one not in privity with the owner) that the (ienor served his notice to owner on . 11~8~?9 _ _ ~
4
19.....----. by-....C.a~.titied. Ma,il__ _ .
(Method of Service)
.Baady...Iasnlation..Iuc.-._..._
Lie
- By.......~~...... ~
Agent or ~y z
• f
Sworn to and wbsai~ed b~f ~ ~ 1S. ~
• ~ th. ........................day of November-........__..._..... _ _...J9']g- ~
t' r r
w'`t f
-
...>1~............5.~"
.
. _ .:.v.o - -
' ~ ~ ~ Notary Public
it '
%is hwna,a-,rl pa/xa~l.'/i,~ t~Nnr t~IC n~~ or t~aro~? at w~
,,i1~1U'?~~.e~er mY coMMissio~, a~ttat Luc. a tom=
;~~~d,z:~~ 303 Cac?diOa 4:~r~.,, . t ~ irru ~ tta. u~s~w~
Jensen Beach, Fla. 33~? ~9
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