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ru ~sn MECHwaics RAMCO FORM 120 `y
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Before me, the undersigned authority, personally appeared ...........Q....... - ~
who, being duly sworn, says that he is the lienor herein or the agent of the lienor herein...-.-•••••.-~----•-••••---•
.
(lienor's Name)
.~v~ ~ _ OC..P!~/ll~.!~... ~ ~~-~~•..-....s~/-'.../r~?c.t°r...LG/f'....~3.y~D
whose address is
(Lienor'a Address)
and that in pursuance of a contract with ~ `
lienor furnished `labor, services or materipals consisting of: (Describe specially fabricated materials separately)
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on the following describedlel property in........ r--Gu/-f,C~....f%~•... ---County, Florida:
iDescribe s~eL property sufficiently for identification, including street and number, if known)
~iil~ ~ 676
~l L~... _...r~lv!¢ . `Pr9s/mil !1 ~ a .
owns y
of a total value of ._~!!~~~..~t/lls,~~.~c~-~ - -~.--.~c doNars (S
lam for which amount he claims a lien on the above `
of which there remains unpaid 5... 3--v
described real property.
He further says that lienor furnished the first of said labor, services or materials on ..~/~r~~v ~jf'~ -
I
~ ~ ~ ~ ~3 . S01 a.f~Q, and the last of the same on s3 ~.7~ . _ , 19 and (ii the lien
/9 .i~
is claimed by one not in privity with the owner) that the lienor served his notice to owner on
(Method of Service) +
and, lif the lien is claimed by one not in privity with the contractor) that the lienor served a copy of his notice to
owner on _ _
(Contractor)
on _ _ _ _ .19.........by-.-_.... -
(Method of Service)
and additionally, (if the lien is claimed by one not in privity with the subcontractor) that the lienor served a copy f
of his notice to owner on -
4460 (Subcontractor)
X4&0 NAR 14 ~ 20 (MethocL~~ ~ ' -
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s ~TY.i-tA. ..lie r
QGER
POtYRAS "S~ t~~ '
CLERK CIRCUIT CO - = t ~ ~ ~ •f~
Agent e•.....••
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f 19
Sworn to and subscribed before me this . _ . _ /.._L~ ..-.day of .
V Notary Public
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1 rlrl~r•~.+ NOTI1tT PU~LK STATE Oi Ai7gIfM I1T NVrr ~ p 3
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