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ri• ,s» MECMwwics RAMCO FORM 120!h
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Before me, the undersigned authority, personally appeared v-d.~.M..... -~..~....1~.v. t/~
who, being duly sworn, says that he is the lienor herein or the agent of the lienor herein,
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.
(lienor's Name)
1 Q ~ Q , ~J~, G
whose address is.....~.`.~.7........'!-`r-..t/...w~........~.~RQj.WC.~.~!...r Li...~j~i~~~...
(t.ienor'/s Address)
and that in pursuance of a contract with e.l l.T ~ ,
lienor furnished labor, services or materials consisting of: !n!+scribe specially fabricated materials separately)
/NSU`A~7joN d- ~oQ.
on the following described real property in ..................~,1.7~...L V el~ ..County. Florida:
(Describe real property sufficiently for identification, including street and number, if known)
Lo75~ LESS ~3 f7. "foCHETNER NiT~ S,SN~ HALF of
!.U 7 tD ['S~ IC l7~ LAKEi~tooD P~4R1C Ui~rIT 12~ 3voK1/
PACE 3c, 3T c.V~iE eovuT~! Fit
owned by _ ~..G.C~L-.__..~~..~R~ '
of a total value of ~~`F.N..~V~~Tfi ~...,X.!.G~!7 T.y S ~x. ~.=~.Pp .dollars (S .
of which there remains unpaid S ~ ~ ~ for which amount he claims a lien on the above
described real property. ~ QQ
p
He further says that lienor furnished the first of said labor, services or materials on _ 2 ~ 2' ~ 6~
, 19 8~, and the last of the same on. ~ , 19_Q.v.-,and (if the lien
is claimed by one not in privity with the owner) that the lienor served his notice to owner on / rr14'C. C ~ .
f
(Method of Service)
! and, (if 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)
1 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
d
of his notice to owner on A ) - -
Ifr (Subcontractor)
on ~6011AR ~ g p}?! 2- 05. , 9 . by
_ (Method~Servicel
FILEU•~e~ECOf~~i•c 1~
` ' St.LUCIE tOJ?ItY.FIA• ~L ~ ~t?
ROGER POItRAS Q
CLERK CIR~1itt C.a.: lienor
~ _ fay
_ Agent
~ , , ~worn,td~ntl subscribed before me this ~ day of l`h~ - 19
~otary Public
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