HomeMy WebLinkAbout0792 -
480941 ~
ru? »n Mec?uM~cr RAMCO FORM 12Ovi
uEN u?w. rs naa
~l~tim ~f ~i~n .
~ ST- ,p
a~~u-~.v n
Before ms. the undersigned authority. personally appeared ~1?..l~.l~ ~ ........`i.. -.......t,., ~ ~~~JS
who, being duly sworn, says that he is the lienor herein or the agent of the lienor herein,
(lienor's Name)
~ ~
whose address is .
...l'~...H..?~1.... C ~ P
t( error's Address)
(f'~_
and that in ursuance of a contract with........
p
l~ G ~.~...C~:~ca.s.~r..-.....R.._~..o.~~..e.........~~r.~..~..~~
\lienor furnished Isbor, services materials consistin of: (Describe special) fabricated materials se rate) 1
9 Y Pa Y
~ ~oc~~ W o v~ l c ~ ~t ~
~lYl Q S ~ 0.1 y Lv a~
1 -
on the following described real property in............~..? .t l ~ ......................County, Florida:
(Describe real property sufficiently for identification, including street and number, if known)
Co t o (o -j-,q N c~ e l~ ~ ~ r i V~
~ N d i ~c ti? I°Z Z v e ~'L C S cc +PS
owned by.....?...'........~.1.~V..19..~?.~:'........t~l..,..-----~~. ~?SS.....W-.-•---~..-~:.1.~...----.~O:S 5.~------ ~~.i...~t1.1. j: e.
of a total value of dollars IS -----~1
of which there remains unpaid S -.raz.. ~ ~ 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 .....0...R.......1~. l~ D..4t.-'~-..... -
` - •~tl
....~1.CJ1.1?..\.!~.....~.. , 19..~:Cf., and the last of the same on..Q.!^. ~.~.O..k.~'....~~~'L t9.g.U.., and (if the lien
is claimed by one not in privity with the owner) that the lienor served his notice to owner on
. . 19..:....---• by--•
(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)
on • 19........-•• bY-------...---........................--••---...........--- - - ,
- (Method of Service)
and additionally, (ii the lien is claimed by one not in privity with the wbcontractor) that the lienor served a copy
of his notice to owner on
(Subcontractor)
on ...................................................................19._......., by......................................................._....-.............. .
(Method of Service!
.r.:ru,:r~r.,.
_ ~ • v n . ; ~i.
~ ~ ~
- - ..yi:
~ .
i ~ -~l
• - ~ :T:
illE((~~ 1?NG F COSNiu ~ BY f.f:..r.~ ..:f~
UCIE GO - ,
CLERK CMCWT LOUR? :
Sworn to and subscr' fore me thi . ...........4? da Of . r ~
y
-
ft~e~ -
~ - t ` i••
Notary Public
'('Iris Inclrum~•nl pr~•pnrrd I?~•: - ~
1~ldrr•s ~ (C' /VG'~• aO~t/IRy OINK AA>t~ OF ftGilOA Ai f1IVCR
~ 1qr CiOMW>iSICM fWMK rAt. A IN7 , '1~
bp(1K Ian 1lift4t G~BilAL MIS . ~ ~b
....c