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itw N77 MECw?wKS' RAMCO FORM 120Y~
uEw u?w. is n~a ~
St. Lucia
beforems,theundersignedauthority.personallyappeared...........~st•as,-,,..~ripht..
who, being duly sworn, says that he is the lisnor herein or the agent of the lisnor herein,
............._....................................w~.tas.......~;xi.Pht..................................---...................--
(uerwr's Nams)
whose address is ............................1 rel.. ~lvpluie...k......................................................................................... ,
(Lienor's Address) €
and that in pursuanceofacontractwith ......................Lillis.....~il~ore-...•..-.~--~~-~•_----~•- ~
lisnor furnished labor, services or materials consisting of: (Describe specially fabricated materials separately(
Put ;~rort an3 3acic door on house -labor
Purchase .~rut:t ar.~l ~ac:< door_ .:aterial~ '
on the following described real property in $.L....~.J,~.1.9................. County, Florida:
(Describe real property sufficiently for identification, including street and number, if known)
1901 tiortt. ibth ~treE~t -
Slakeu-::/L 31r 2
t,~e:r~r:,~:,t2l~rri
K~3 J = T f LG t 22
y
owned b Lillie.-ail~urc,
ofatotalvalueoi....Tiff..t1!~?'14.I'°~---I<.aS~..~~$~t<y.-~~Ye-A~...Ce;l~....--------dollars ii ~QS•n~
s
of which there remains unpaid 5---..1'ri,~'~` .................................,tor which amount he claims a lien on the above
described real property.
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He further says that lisnor furnished the fiat of said labor, services or materials on
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j +..c.t....15 .............1979...., and the last of the same on. ~~t...~~.~-.........----..--..-.....197::'......, and (if the lien
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is claimed by one not in prrvrty with the owner) that the lisnor served his notice to owner on ,
a ~ _ i
~.ct.....lb .1~.:=......,b Y~r~al .igree~ert------ r
. y.......-------
(Method of Service)
and, (ii the lien is claimed by one not in privity with the contractor) that the lisnor served a copy of his notice to
owner on
1 (Contractor)
on ,19.........., by......... ,
...y......
- (Method of Service)
t and additionally, (if the lien is claimed by one not in privity with the subcontractor) that the lisnor served a copy
of his notice to owner on .
(Subcontractor) I
C ' ` G (Method of Ss ce 1
ir/ ~ i
a FUEL' anE hiC 1)
ST.tl1CtECG1?I(Y.fii:.. ,1
ROf"aflt F'G4TRAS -
CLERK C:kU~7 CCI,Ft ~ or
(v
R%CCP~ ~'~~'~'z ~ 9
~ ~ • / Age
- G Yi / ~ f//
Sworn to and subscribed•befors ms this:.:. 4s f ~..t. ~~1FJrf a.~':u;.r;/ .....................................19. u^..:.
Rotary PubKc, State of Florida at Large = ; ',t,
fJly Cosnmissi~n Expres 1~ne 11, 1982 a.-a- .
k,.z.a ~.,.,•w i... a c,w+x. co~..r i. ~ r ~ ~ ~ otary Public -
This lnslrunu~n? pyr~parr~d h~•: }i:,r}~e^ie,~~.~:i ,t cF ~ .
of
Addrr~c.~ '•1? 7t~ :.t-?t. Fi=~rcdi ~~i R~ ~~V ~ ~ 1 ~O
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