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sefore ns•. tM w~dersi0nad auehoriq. pM a~+d...
who. being duh sworn. ssys fiat he k the ~ ~ ntor herein or tM a8ent of dN tfenor N...in
GLOM D~If4.
"fl~h~''s Nana!
2201 8.. ~ndlas 8tswt, i~ttuart, Roritlrf~ 33494
whose addnse b ,
lf.Nrwr"s Addrea)
and that in purswnoe d a contract wHh..........le':~~ .~~~Q~..
83~..C... :.111 . ~1.. !!~01•'L i~C ~ .~~..tCaWC,i~ti~.~~~~
lienor turnbMd labs, servbee or rnptariats. cor~atirp of: lOeecrige sp!daih? hbricated materials sepaatehll
~IeCrLS S~[G YJ7lD0~i8 uD 2ii.~G t~h88 P0088 995.51
........................................................Cou .Florida.:
on the fdlo~nrirp deuxibed nlal property in St. I+rio3+i ~
lOescribe rNl propeetll ~ for identification. indvdirp street and number. if known)
hot 13, u1oaY 71, unit 15
2502 Prot san8, Port St. Lnais, Florida
owned Iw .~i
.S. Xi..~.................................
of a foul value a~~Al..~.~A~7.~~~..~..~~#..Q'~A ..dE dollars li ...5.51
......................1
I' . for which amount lre claims a lien on the above
' of which there remains unpaid i.....~•~
described real property
I
He further sacs that lienor furnished the first d said labor, services or materials on
..,....,1~~ , tfii.:......., and tie last d the same on............1~.-............... , 78~....., and IN tM lien
h chimed by one not in priviq/ with tM owner) that the Heeor served his notice to owner on 2~
!Method d Service)
and, (if the lien is chimed by one not in privit~? with fire contractor) fiat the lienor served a ~P1? d his notice to
owner on ~=~414~~..~..~I~R~A. ~s..~4~4~t~
lContracmrl
on ............:.....~},~,.80........................................18.........., b11...................(NS"titfA~•~3.......................... ,
(Method d Servigl
and additiora~l. lif tla lien b ctsi~d by one not in privity with the subroontractorl that the lienor served a copy
Y`
d his notice to owner on
ISubcontractorl
1..
. on .....................~~...........................18........., by..........................1Method dService)................. .
1980 FEg i~ ~ ~
~ ~ ~,,!c~ a Pbrs
~~p~ sy
Ma ti~~7,~ ~ .......................1i.
Sworn to and wbscribed before me ds1t~1~~ t .
Swe ei i~•~:~ 710l~14~ta:
(1~[.
~14r„ , u.
Thin Inatrumenf prepared by: ~y G~s+oa E~iwt ~ 4 ; ti ~`/9
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