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FLA. 1967 LAWS ~ 11AMC0 /ORM IsOM
FS '713.08
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~i>atte of ~lariDx
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Before me, the undersigned authority, Personally appeared.... . ~..m._ . ~-f-~.h.1r......... .
a ent tt
who, being duly sworn, says that hs is the lienor herein or # the attorney S °F the lienor herein, .-.O.W£.~+
(lienor's Namel
whose addreu Is _ ........Tl~~ _ ,r !
(lienor s Address) `
and that in pursuance of a contrail with . ~ ~ ~ 1.~~.~~
lienor Furnished labor, services or materials consisting of: (Describe specially fabrica~d materials separately)
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s
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of a total value of U N~~~ ~Q dollars (S )
d
of whidl there remains unpaid S ~ V ~ ~ ,for which amount he claims a lien on the following
.described real property in County, Florida:
(Describe real property sufficiently for identification, including street and number iF known)
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n ~~11
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Owned by ~4~. ~0~ ~ ~!~S .
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He further says that lienor furnished the first of said labor, services or materials n
~~a
191, and the Iasi of the same on l ~-.i.~.., 19 r and (iF the Gen
is claimed by nol in privity with the o er) that the lienor sew his not a to ow er on .1,./r~
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(Method of Se ice
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By
Ays~~c.lr2.t',~ y
Sworn to and subscribed before ms this...._ . _...~.........._.......da of _1q Q .
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Notary fhl~
t;rta>~ P~hhr, c~-ao Ct` Ft~+~d0 At C?•~°
My ~1lltm~:,w~? Ea~~'~:s tiler- 1~oL
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