HomeMy WebLinkAbout0285 FLA. 1Y67 LAWe IIAMCO fO11M 1=011
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Before me, the undersigned authority, Personally appeared......--.-1~.tt,1~At1~1~..7~... Sto.R6
who, being duly sworn, says that he is the lienor herein or 4 the agent of the lienor herein, .
1 the attorney
..................................Kenneth..Z.....3~,nae...d~b~#~...Re1~...S,tone... Soa-.Pluabin6.................................................:....
(lienor s Name)
whose address is ....................1119...~1,a1leda...~lvenue... Pbrt -Pisrcee...?'`~~..........33!;5~......... .
(lierlor s Address)
and that in purwance of a contrail with..- _~,u~s .Cats..... d.~bl8......Csta. 0onatru-ction. _
lierlor furnished labor, services or materials consisting of: (Deuribs specially Fabricated materials separately)
Plu>,bing piping, fittings, faucets. fisctures and labor to install sue.
of a total value of-----Tfra.-thctuaani_one hundred .---.-.-.---------...dollars (S 21~.~. _ _
of which there remains unpaid s 2100._00... _ ,for which amount he claims a lien on the following
described real property in _ ....................5~,. LuCie_......_ _ . _ . -County, Florida:
(Describe real property sufficiently for identification, including street and number if known)
1330 F~8- 22 Pik 2- ~
44q 3. is. Seabreese Dane Ftt.EO a;~% P:cun::t::
~ Si.l_l'CtE C4L'N~Y•F-t A-
~ Lot #].4 Blk• 248 Tract 6 Ra~~~ ~v1T~r
j CLEFK C+4C'~IT CQU j
4'6913
I
Owned by-----Luis--.Cats..d/..b/a...Cata_ Oonstruct~.oti _
He Furthar says that lienor furnished the first of said labor, services or materials on...-_
Au~uat_-.9....._......._, 19--~-, and the last of the same on .--J$AR...?....._....-. 19~. ,and (if the lien
is claimed by one not in privity with the owner) that the lienor served his notice to owner on -
19........., by.... _
.(M thod of Service)
lienor
By _ _
Agent or Attorney
,
'
Sworn to and subscribed before me this ..........................:..........................day of _ ;'19 = :
--Notary lfubiic, 3tafs o1 FloridaY at Grg~ Ct _
My conlrlwuwn res F ~ • _
. abrvary 4.196E •
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- l,trwyers Surety
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