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4'734 .
n~. wcw?~cr IIAMCO fOtiM tlOK
~ Martin
Before me. tM w?dasi9ned wthaitt?. ph appMr~ •-•=••`TT'8•• C•*... -
who. beirq duty sworn. says that he is the liana herNn-or the pint of the Naror herein. . .
A~r~f~.'l~~C.. ~~~~~x... R~..S~uau~~~ ..tea .
Itisnor's Name1
whose address is.......~9:e.?...5....D~iai~e..~r...,...stud=t.....331~9~
. ~
and that in pexswrwr of a camsct with.Ds?11g1as..Banes..fO~c..N.~G..Ii.-.Savestmt3xlt~ • -
. lienor furnished Iabor. sefvioes a matsriNs eoca~istpq of; - IOsswibe speeisHy fabricated materials separately!
1-MODRLs 2500-F, Automatic Iron Filter -
1-MODSLc- 250Q-30, Automatic t~tater Conditioner _ - -
1-MODffi,t -590-D-8x44, Taste ~ Odor Filter ~ ' -
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on the followirq described na1 property St.. Lucie COUntx
.....................................C~owrq, Florida:
(Describe real property suffider`dll-for idsntHication, indudirp street.and number, ~ krawn! -
10809 Indian River, Dr. , Ft. Pierce, FL ,AN 22 ~ ~ 22 - -
. 4'734- F~«o r~coid~Q
s utc>E coutty.f~w.
- aO~ER POITRAS .
- - CLERK CIRCWT COIJit -
N. G. H. Investments - ~ ~ -
owned by . - - -
of s total value oPne-th~cusand-four-hundred ~ ~~,~~y-Q~bu.~s 1= ...1.451...84_ ....:.......:.1 -
.x..84 cents
k -
for which amount fa Maims a Uen on tla dhow
~ of which there remains unpaid s.... 1, 431.. 84 - - - -
described real property- '
He further says that lierwr furnished the tirst of said labor. services or materials on 24
--..OCtObet---•......_...... , ts79.... and the last of tM same on__~~.: Qct~olb~r ...---......19.?9.... and lif the lien
is claimed by ores not in privity with the owner! that tM lienor served his notice to owner on.._.__W..ed~t~l3d,a~---- -
-16:--JanuarX te..80_., by_..US..Mal. -
IiNethod of Service)
and. lif the lien is claimed by one not in privity with the contractor! that thNienor served a copy of his notice to
~Oritract0!!
~+-------16•---.January ...1s.........., by....:.irIS--Mail.................... -
(Nlethod of Service!
and additionally, (if the lien is claimed by era not in privity with the wbcontrsctor! that the lienor served a Dopy
of his notice toowne: on
- iSuboontractor!
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(Method of Service! - = _ -
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Atl~t~l,G...~,7~1~7C...of._ t 's - 1 t"', -
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Sworn to end t11blcrlbed befere_ , ; - Of ~ - , *4 .
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- _ art DUI Aftt yl -P~~` ~ . ~ .,it
-This Irts?rtrna•rit rr r !t MY OOMMKSlo~+ E7VlAES s w33 -
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