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Before m.. th. ~w~dersigned authoritrr pusonaNy a~psarad : ..../..~~/,dG's~~L,~~i -
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who. being dt~ll? swan, safrs tf?st he is the Iiei+or herein a ~ spent of the lierwr Fein.........
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cj,~......~1~,?~,~.~~...............................:................................ .
/ (Lienor'e-Name1'
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whose i:.... a~~......,!'~,~°r ~....t?~ F..~...;-..r..rt'~
ILienors ~tddrass? - -
and the! in pursuance of a contract with~,f-.: ~r ~~~~~~n (~J~• .
iisnor furnished labor, services or matetiab twraisting of: lOsscribe specially fabricated materuib separatelyl
~i1'G , ~ !1,sTc~ //J,.S~ ~/af/ex fhl~ cS~t`~ dc~o~'IL -
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on the fotlawi~p described reN property in......t.~/..r....~!l~rG
...................County. FkKids:
. - IOespibe real property sufficiently for identi~tion. including street and number. d known) '
,4 tee/ ~yerre 1~.~• .
. /6 its described ih L~' , ~%4I ~~3~errd ~c?.~ a~6'S. f~' ~~s= - ~f /b; - - -
- owned b~-- ,~..~tfe.,~.. r..../.~f~.'/~~C ...f~.~0 .....~~o..r....J..e .r~ ....~1~~
- /3~ JS(G~rrtst' i4tks Ft. ~ '~q~d- -
~i CG IC.- 33 ~S-D
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of atotal value o~T4t~7~Jf...'f.ZC7fr--.~tQ~... ~....d9'CL><~.. dollars (t .C7~jf.'t~.. t~d.~..Jj~
of which there remains unpaid s..~~t..~Q~~ for which amount la claims a lien on thb above _
described real property.
He further says that lienor famished the first of said labor, services amaterials on -
-•--------1.,/.U.~EIt~....-../~.. ,19 and tM last of the same on .................C/5.;~:'~:... ...19..7 f`..., and lif the lien
is claimed by one not in privity with the owner) that the iianor served his notice to owner on -
~fi y - 1 -
.r~~.~~....a., ................:...19.~~....,byJ~~L~~!~Q'llflf°rlT......~/~/G.r
°f,.,r...~1!/~'l.~G.. ~~f
(Method of Service)
and, lif the lien is chimed by ores not in privity with the contracts) that the liens served a copy of his notice to
.owner on
IContractsi
- (Method of Service?
and sdditionaily, lif the lien is chimed by ores not in privity with the subcontractor) that the liens served a copy -
of his notice to owner on
(Subcontractor) ,
. tt - -
............19........... by........
i EO I?IiC !~ECOIiDt D (Method of Service)
g~f.llCtE CG'.NITY. Fl A.
- ROGER f`OITRAS ~ -
CLERK CiACiNt tf~lRj ~ - -
RECORD ~lf'gtFiEC~~--~-~--- - -
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Swam to a bsfor _ _1~ j _ ~.'t' ~ . s,,
red subscribed e m this__ .-da~r of ~ ~ -
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