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FLA. IYa7 LAWS RAMCO FORM 1lOr
FS 71J.Oe
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Before ms, the undersigned authority, personally appeared......._~.'...... .
who, being duly sworn, says that he is the lienor herein or ~ the agent ~ of the lienor herein,
the attorney
K~11~ Bros. '":•actor Service, Ix:c.
(lienor s Name)
71S ~Lidw3;; .'ui.~ r±. PLt:rce, Fla. 3350
whose address is _ , . _ _ . _ . _
' ' ~ (Lienor s Address)
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D: e~~s P~.•.itrbin~
and that in pursuance of a contrad with---.. _ -
lienor famished labor, services or materials consisting of: (Describe specially fabricated materials separately)
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BacIk~oe *.•roric ,
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FYve h~.n~*•^':: -~i °2'_ f`iz c roc/100 • 525.00
of a total value of _ ..dollars (S - .
00
of which there remains unpaid s ~ ~ ~ - - , (or which amount he daims a lien on the following
St., =uci~
described real property in . _ _ _ _ County, Florida:
(Describe real property sufficiently for identification, including street and number if known)
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Owned by _ . _ _ _ _
F1e further says that lienor furnished the first of said labor; services or materials on - -
' 19 ?9 ,and (if the lien `
( 19...9..., and the last of the same on ,
is chimed by one not in privity with the owner) that the lienor served his notice to owner on .
, 19......., by. •
f - ,;,,a ~ (Method of Service]
~ KSS. r:~.;y;I"%,,- 1 •os. "'rec~or S•_r:°ic~•, Inc,
~ • 1' ~ ~ ' ~ Lienor
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R .it ~ ~ - Agent or Attorney =
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f' - subscribed before me this......... ........day of C 19
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Notary Public
T l ; '1 Notary PuDf~c, State of Fbrida at Lir~B ~ t
'/%i:~ /ut/nn~irir~ /err/arrnl lit': -.z__.~ Y,~:wl;,"
91 .,Pi ::Orr i1 . My Commission Exp~rCS Cecember 17, 19Q2
.1.Lln Bonded ttuu . AAaynard 8oild;n8 a~a^oY
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