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4`76848
FLA. tr/d7 LAWe RAMCO FORM ti0•
Fe 71,.00
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Before me, the under:i~ned authonty, Personally appeared . t
the agent t ~
who. beau duly sworn, says that he is the lienor herein or ~ the attorney { of the lienor herein, f!
i
(keno's Name)
whose address is .............:..S..l..~................~.~.
(keno`s Address)
and that in '
Pursuance of a contrail wrth--...... Sa ~'1~....._. ~5?~.
lienor furnished labor, services or materials consisting of: (Describe spedatly Fsbricated materials separately}
. by
of a total value of...~j?.~- Ian (i v
rr ~ .
of which there remains unpaid s..lQ~~....... for which amount he claims a lien on the fdbwing
descrrbsd real property m..--~~~.._`..-~~.~_ _ County, Fbrida:
(Desuibe real property sufficiently for identification, including street and number if known)
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Owned by ~1...?~.31....._.- . .
Fls further says that (ienor furnished the first of said labor, services or materials on- ,
eC......^ G..
s~...0 19~gand the last of the sama on ....~.J~'_~ f9 ~ . and (if the lien
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is claimed '
by ores rat in pnvrry wdh the owner) that the lienor served his notice to owner on _ _ . 3
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(Method of Service)
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ROGErZ Pt31TficAS .
CtERH CtHCU;T CCURt e~ A9ent or Atlornsy
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Sworn to '
anc~ su~sa`~sd bsfor mr t4ns- ~
~ ~ -
ary Public .
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nnr a~Nwutal w~ arl~• • II~t
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