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IIAMCO fO11M 12054
~ »n Mecwur~cr
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Before r11e, the SxSdersigned authority. personally appesred
who. being duly sworn. says that M b tM INrSw herein or tM agent of t11e lienor herein
....P.a,~.m~r...Gnnstruction...Inc........Le.e..t~.....palmer-•--•-Fr-es.,
IUarlor's Namel
whose address is....I'...A.,....~Ax..b21..Pa].m...Gi.tyty...F.LOY•~.d8...~3 j~0
ilierlor's Address) ~ -
and that in punlwnce of a contract with... Baint.-.5.outh..$uilders.• • • • ~ h~~-•Zri-ller .
. Port St. Lucie, Florida .
lisnor furnished labs, services or materbb consisting of: (Describe speciaN11 fabricated materiab separately
Carpenter work X80 fE6 ! I A!! 01
Labor and flails r~C~+ryQ ~E~ N1
4 / aJV ~ V STROGER Oi?RASI~I.
CLERK ClRCWT C T
RECOR9 YEf!i't:'0
County, Florida:
on the followir5g described real property in............~~.~.tr...~r.1~1C.~.1'a--•k'.~l
(Describe real property wfficiently for identification. including street and number, ff known)
Lot 15 Block 409 Sec. 3 Plat 3ook 12 Pale 13A-13i
886 ~ ~,var?r-en r -:rr
Port .~t Luc ie r Florida j,;r and t~:rsr~t ~ r r I~~~t~o......l.o~r.:::rs-l----
owned by -
of a total value of . T!KO...T.hAUSarid.-.t3,u.e-.. d •••F dollars li --2.r.~O4 ..60
................1
~~y ~~~ts
~ 50t{. ~_Q, for which amount ISe chime a lien on the show
of which there remains unpaid i
.-;a;a:bed rani property
' Ne further says that lienor furnished the first of said tabor. sarvk~s or materisb on .-~OYambsr...1.7............
,1s.....7~, and the last of the wme on..NQU~tribel'22............19..~~... and (ff tM lbn
is claimed by one not in privity with the owner) that tM lienor served hb notiw to owner on..i~.eG-pfflt}ein•• 1•~---•
ts...7..9..,m?....met:'ta.~~cdl..~`,a.i.1................................
(Method of Service(
! and, lif the lien is claimed by one not in privity with the oorltractorl that the lierar served a copy of his notice to
f
................~:......~x~.....~i.Gt~ard..;>Tiller......................................--------........
Point South 3u ldP
owner on
(Contractor
4. llec ember 12 ts...Z~., ......hail ,
I on
• iMethod of Service)
and additionally, Iff tM lien is chimed by one not it, prnrity with the wbcontractorl that the lierlor served a copy
i
of his notice to owner on
(Subcontractor)
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on. ~ ....................•-----.....1 y................---.......---..............................
~ (INethod of Service(
-
c at ~~fi....,~~
''~~cti~'~ .....Palmer...Gonstructi.on•--I•ncr•--Lee--~•: P lmer
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Sworn / , ~ this_..~~ 1'Gn.._.....+._day of ~ ..........................1 s..~d:.
tgarld~~ ; ~ -
, ti3~rfr `ice
. • - -...........110?/IRf IIRI11E-Qi !{~ORIOiII A~ Nltl~
This /n.~frrivirnt prrporr?d~bfy~~ ~~~ugf~ p~~q~
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