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iLA. lee? LAWi 4'76915 ~ 11AMG0 FORM tao r
Fi 7/,.Oe
~l~ttlli ~t~Yi
6eforo ms, the undersigned au!tiorify, Personally appeared ..................KR.rinetth..L....StQ.~?~._ !
who, beirq duly sworn, says that he ~ the lienor herein or the agent of the lienor herein,
the attorney
..........................Krennath..Z,....Staae......d~b,~a......1Gsa..3tons ~..Son..Plushitct~g:..................................
(uenoi s Name)
whale address is --......~11~..,(I~gd.~...Ax~t~t~te....1'~4z't. Pierce.... ~..._.......33!ar~ _ ,
(Lienor : Address)
and that in pursuance of a oontrad with....~~.d .C0.ta ....dlbf~..C¢ta...QoA$t]CUCtioii............_._ _
lienor famished labor, services or materials consisting of: (Deuribe speaally fabricated materials separately)
Plu><bittR piping, fittinga~ faucets. fixtures and labor to install ease.
i
of a total value of-..TKO....tbousand. ttro.. hurxired dollars (s ~2pp~pp )
of whid? there remains unpaid s . - ,For which amount he daims a lien on the fdbwing
described real property in..-..-....___.-._ _3t.....~uce..... _ _ ...County, Florida:
(Describe real property suFfidently for identification, inducting street and number if known)
2502 3. E.- Petit ,930 ~`ti 22 2: 54
~ Lot ~FE13 Blk. ?1 Tract 5 ;
~f ..un::t ~l )
F LEO A'l ~
I ST.l~C1E CG'.VTY.fI.A.
f ~ ROGER POITttt.S
{ ~ CIER!'. GtRCUfT COJi.' Q
a=rear=a<<re.- r
- 4'76915
Owned by........Luis...Ca1a:..d~b~~.......Ga~ta ('.Qtltt3txtl.SaiQn . . _
{
Me further says that lienor furnished the First of said labor, services or materials on_ .
...............,S4Bt•..
~6,............, ~19..~., and the last of the same on ..._~~n-..:..2Qs....................--. 198 ,and (if the lien
is chimed by one not in privity with the owner) that the lienor served his notice to owner on . -
(Me od of Service)
Y
By- _ _
Agent or Attorney
Sworn to and wbsal'bsd before ms this y of ~-P~'."'..... - - .19..- ~v .
Notary Public, Stets of ilorida at large ~ ~ , M,~i~;
My commission expires February 4, 1981 ~
bonded with Lawyers Surety Corp, _ _
- . . Notary Pubdc- - ~
r ti ~ ~~.1 ~ . -
- _
1 %is brs~mrn~rr~ l+npnrr-J ~ • ~ ,t'~' \ . :
BOOT( PAGE x.07