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Before ma, the undersigned authority, personally appeared.-~~Q~C~..Y~.~:~..~~~?I~._.~~X.~?~.-~~Q~?C tS
who. being duly sworn, says that hs is the lienor herein or the agent of the lienor herein,
ARNALA HAS S d/~/..a/ Gex aua~.~... Ca~aep~ s -
(lianor's Name)
whose address is......20.Q...Nax.tkl..Oa.d...Aa.~{,j,~..N~ghwd]i.,... pupa,t.~r.,....Florida...33.4.58....... ,
(lisnor's Address)
and that in pursuance of a contract with ............GENIE...WILSI~N .
4.49.• SW_. rakehurst..Drive-,.-. Port.. St..•-Luc.ie~• .Florida .
lienor furnished labor, services or materials consisting of: (Describe specially fabricated materials separately) j
sale and/or installation of-ceramic tile, sunken tub, and other
miscellaneous bathroom fixtures as per contract dated August ;
21, 1979.
on the following described real property in St . Lucie County -.....County, Florida:.
(Describe real property sufficiently for identification, including street and number, if known)
449 S.W. Lakehurst Drive
Port St. Lucie, Florida
owned by...... GENE-_ WILSQN
of a total value of Two--thousand_-dollars douars IS ...2...000-. 00..--......-...-)
600.00 ~
of which there remains unpaid S ..........................................,for which amount he claims a lien on the above
f described real property.
I He further says that lienor furnished the first of said labor, services or materials on .........AUgllst ,
21 , 19.....7.9., and the last of the same on...-&eptemb@r--.13.... , 19....7..9., 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
................,19.._ by. ,
(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)
(Method of Service)
~ and additionally, lif the lien is claimed by one not in privity with the subcontractor) that the lienor served a copy
i
of his notice to owner on - -
46'738'7 (Subcontractor)
~ V VC7 I
1iw . Zs ~ - U ( (Method of Service)
t
Si.u;riE ct ,~;~y.I; ? CERAMIC..CQN~EPT.$ ;
ROGEn f Fi ~ ~ lienor {
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9 By
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Agent
f`svrom to and subscribed before me this........ Z.~~
...........................day of .....ND ?~~!J~~`~.
- ....................19~~-. ~
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i • _ ~ ~ .
W'LLIA~IA W~.?S ~ - Notary Public ~
ATTORNEY AT lAW
~ %Y??s Insln?nu~nl prr•pnrr~il h~•: Motur h~ic, St+te sf flori~a of laN
• P. O. FIOX 3365 - ~ . , „ I