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rM? tat wcw?t~CS' IIAMt:O f011M 120ri
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s.r«~.m..~h:~wtarai„~.~.~a~«+t,,.p.~.o~,?.op..~«+...1~!t!,!J1~!~../.~ ~.~~Is~fF~
,~,o. b,h,8 dull, sworn<aays thth. is th. i~tor h.~.~ a a,. a~ aa» h.r.i~
~~~€~~i2T.~..~ ~4 .7~~r...~~i~.~.re1~~r.....:........:
tu.~«•. Na~t.~
iRiartora ~
a„a that in . a a Contr.otwith...~~~...,r.Qr...~~/1`~l.~
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a.no.~ rumi,n.a l.bor, s«vlos m.tri.k of: to.w.w. h hibricated materiab sapantdy~
2~E~-~h~2.,E ~iilliS~l -
on the ds~+b•d titiMpr~y in... 5'?..~ ~G~~.: ......:....................:................cou~y. Florid.:
toacribs ~ ~oa•~r suttici.rtW fa ia.rttiiicaaon, itdudinp street and numb... if knownf
7 9 ~~1 B~T~ V~~eF .5`r~rai? WAGON
own.d by....1.~~.c~~~r'.~t...l?.~`~s
aal.n is a2~.~%..~...o .:..:..t
of a total vNw of ....~.cJ~.~ ~f1
~~1.~! ~O ......,for which amount he dsims a lien on the above
of which than remains unpaid s............••••••
I as«ib.d ral pro~t?•
H. further say: that lianor furnisltad the firer of said labor,:ervices a materials on
..~v,~.',r . ~s..7.~I, and th. ia:t of tlr. s.me nrt... ~f.......~f~........ , ~s 7~., area tit th.li.n
~ es daimsd by ores not in privity whh the owner) thst the liertor served his notice to owner on
..........................................18........... by...............................:............................................................................... ,
(Method of Service)
and, lid the lien is chimed by one not in privity with the contawtorl that the lianor served a copy of his notiw to
owner on
lCorttracwr!
on t e........... by...................:...................................:................... ,
(Method of Service)
and additionally. lif the lien is chimed by one not in privity with the wbt:orttractorl that the )lector served a copy
of his notice to owner on
tSrlbcOrltrraCtor~ ~t~~.uN~np~.~~%~~~
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~~~4 (Method of Sirvic~71'1%~ ~ ~ .
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of~..... • .................................18. ...d
Swom to and sub16 bitloFr~i
niar day
Notary Public
This /rtsinrnrrrrf prPparrrl6~': rglAA~ ~K AAtE Oi gplpl N t/~it
_ .4dr/r~~ss Mr tAMlwStitkl t}liI1RK MAB. M t~