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ILA. 1De7 LAW! RAMCO IOlIM tiOr t
Ie 71,.0e
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Before me, the undersigned authority, Personally appeared .
• ~ the agent
who. being duly sworn;, says that he is the lienor herein or the attorney of the (ienor herein,
(lierwr s Name)
whose address is..~•.Q....~:........~.~.~
(Lienor
s Address)
and that m pursuance of a ooNrad wdh.:....... ~ T~.......~,.1L~1JS.~.. .
lienor furnished labor, servioss or materials consisting of: (Describe speaally fabricated materials separately)
R ~
of a total value of - ~JO..... . _ ...doNars =
a. ~ ~ ,
of which there remains unpaid s for which amount he daims a lien on the Fdtowirg
desvibed real property in-..._-..
County, Fkx'ida:
(Describe real property sufficiently for identification, including sheet and number if known)
!
owned by .
Fle further says that lienor furnished the first of said labor, services or materials on _
l C~
---...~v
~ ~.a..-.~..~..........., i9~ Band the Last of the same on Ol~.....~ ~ 19~...! and (if the lien
is daimsd by ons2not in privitccy~~with the owner) that thte
liMenor served his notice to owner on _
(Method of Service
I90 Ft~ 22 Eu T n ~~--~.~+.s~s~..... .A~~- .
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9LlUw;F C~?:JYTY.F! A - By C~{!vl-~!'
ROGER POtTF?AS
CLERK CtRCUtT CJi~ T~ Agent or /Utorney {
sccclt e'=aft; J'" -
Sworn to a~ str~6sai~id fore rtt ibis . -
*,~:.~.-............day of
>9. Y
t s Public '
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