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FLA. 1.e1 LAWS ~ 481401 ~ 11AMC0 FORM 1ROr
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Before me, tM undersigned authontY. Personally appeared Asst _ _ ~
who, be+n9 duly sworn, says that la is the lienor herein or # t t~~r~Y ~ of the (ienor herein,
A~slill~
whose address is... 33SS..5~....~.'.rlS l ~ S:fu!t'!~! flt.. 3341
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(lierwr s Address) j
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and that in pursuance of a oontrad with....... D'E'C' ,
1 f IY,W,,~ ~d3~ St, Mai Flre. 33 f6! ~
li.nor famished Tabor, servioas or materials oonsistin~ of: (Descri6s specially fabrica?ed materials separately) -
M.arc~ct~,u1 .n~d(~/I}~/z{~a~t~~.,CG~(2 ~i~e (4~ ~ali~+9w -
of a total value of-- ~iatrGetalf._ Fi~~S~e---'..dollars (S~d56.00 - . _..j
ae+et~ :
of which there remains unpaid s ldS6.00-- for which amount he claims a lien on the fdbwirg
St. --County, Florida=
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described real property in .
(Describe real property s~uffiaar>tly for identification, indudin9 street and number iF known) -
TJ~ PLw -Fiat Piewu, >13a2 N~Lrsas~s Aye., Tint Ps~cce, Fle. 3345A.
• 19~ MAR 3 I P~ ~ t S
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POITRASA~
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T F• p.. Dear - ---'rl' , -
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P..~ .........tit.........1.e.~..
by..........~..... ~
Owned - i
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He further says that (isiior famished the'first of said labor, services or matsriials on-..•--'23-'~!~`.......
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~ 19-~~•, and the last of the same'ori ~s-...~a~ ~9 d0., and (if the lien
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is claimed by one not privity with the owner that the li4nor~ ~srvcd his notice to owner on ~ _ ~
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( ~ 19......... b ~,~~Cttal.l~w~.~tf-..A~Itet.<A't. -~~qr~e _
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- (Method of Service) -
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Sworn to and siibsaibed before nie this day of
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Lary Public -
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