HomeMy WebLinkAbout1819 hh,,,,~~
na 197) MfCtiwN+CS /O~ RAMCO FORM 120'.
LIEN LAW rs »>a _ VV
~liltt of ~loriDu
~ait:d~ of
Before me, the undersigned authority, personally appeared ~AtI. ~ ~`~'s(/
who, being duly sworn, says that he is the lienor herein or the agent of the lienor herein...... _ . _
Gul~,D l,f.~„c~.~ . -
(lianor's Na e)
i
T X11 ...,~o x ..2.7,.. ~ ,E,~~~ 1=~(...~33 yS~ _ .
whose address is
(Lienor's Address) "
and that in pursuance of a contract with ~a./ /4 ~m/~.ts~rh?.~!Ti .0~'V. r~. _
lienor furGnished labor, services or materials consisting of: (Describelspeciallylfabricated 'm'aterials separately)
i SI~wO;' ~or' ~/10~0~.~''i Oil G Si TC w~0~'IC. .
u+ _ Count
on the following described real property in. .....c G/. " _ y. Florida:
(Describe real property sufficiently for identification, including street and number, if known)
a. G ~ $ i t n, ~ '~s. r,n:ln~ ~ ~ s Jcli f7 ~
~ec.~~";
oN ; y~l p 5~~ . 5~`tJJ~.. ~D~ L G Z c~ ~~l wf?
,cam t ,y, a%~~ ~urY , R`r' s, ,cam , scc.~~•y
owned by +.U~I.~i....~i _ ~jJt~I~7 _ _ -
L a do
of a total value of . ,~0. ~JW h _ ava . /
~ _ donars (s .I[ O "O.. _ _ . _
of which there remains unpaid S ~ u-'! - ~ ~ .for which amount he claims a lien on the above
described real property.
He further says that lienor furnished the first of said labor, services or materials on
I c
~f.~. ~ T . , 19 ~ and the last of the same on.. ..Q£C.. ~ , 19 ~ and (if the lien
is claimed by one not in privity with the"owner) that the lienor served his notice to owner on
~~d. ,L~l .,9 f~ .by GC, 5.... oaf~C. ~a~:
(Method of Service)
and, lit 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
of his notice to owner on ~
(Subcontractor) i
on . 19 . by _ _ _ ;
tt
(Method of Service)
a 4'79'765 G~'i,~ Q _ j K ~,~G T~"
i"t. t
. ;H~,R 17 Plt ~ 35 I_ienor 2
6 ~0 ~flf Ff CU r tl By
'9~:L~'CIE Ct)itfl~y~LA. ~ Agent
' K/ -
Swbrn to and wbsc?ibed befolglTtiB tFiis u~ . ~ _ .day of ~l~~G.-- 19
~ ~
~ l I Notary Publi
1'1?is Inslrrrnuvr prr•~inrrrl h..: _ N01~tr IIf+1JKK BATE OF ~I~'t
1 dd r~•.. , Mr GOMwSilfiE f)>fr1~r IfN~: fr> /KE `/~~1
~y~~y y~
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