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ru H77 YEtNAN~t{' gAMCO FORM 120~i
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~ Broward
Before ms. the undersigned authority, personally appeared I an , . G . -..Park.. • . ,
who, being duly sworn, says that he is the lienor herein or the agent of the lienor herein.
-...•.-••.Air.•Conditioning..Equiprient,. ••Inc.
(Uenor's Name)
whose address is .........................821.- NP1 5~- Place•,. Ft.•.,Lauderdale, Florida 33309 .
.
(lisnor's Address)
Air Conditioning of Stuart
and that in pursuance of a contract with....-• .
2873 SE Jefferson, Pt. Salerno Florida
lienor furnished labor, services or materials consisting of: (Describe specially fabricated materials separately)
Central Air Conditioning Systems, Materials
on the followin described real r St. LuCle .County, Florida:
9 P Wye'rtYin
(Describe real property sufficiently for identification, including street and number, if known)
See Attached Exhibit "A" •
owned by ......................Pines of- Ft. Pierce Development Corp.
Fifteen Thousand One Hundred Forty 15,148.00
of a total value of do~r5-(T...........---...........----•-
of which there remains unpaid S-...........1.5-,-14 $ . 00--------------•, 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
January 21 .19...80., and the last of the same on...... January 21 , 198 and (if the lien
is claimed by one not in privity with the owner) that the lienor served his notice to owner on
..--._..---March .9.-..- ,19 80 ,by Certified Mail
(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 DIC :Construction
ssContractor)
March g _R 0 Certified Mail
- (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 ........................................I~~A.........................-----.......................................................
(Subcontractor)
on ........................19...........by--.............................-............-----....-
(Method of Service?
Air Conditioning Equi t, Inc.
ieno
BY
r~ t
Sworn to and subscribed before me this.... J I ..............day of ................C..t r` S''~ 19.F~'..
f~l0~Tl11iY r~ulc sT~tE of aoluor? ~T t~?i1GtE f_ ~r _
Mr COM~niSSION F%?IRfS SEDT. 2 19j: .......'..;.~,c.. ?.~Cs~ ,'1~~i, 'a:'~ .
IOPDfD ?MRtJ : E?~ER~u iNS . tJMDfIWRI 11~otsry Pd61i
"!'Iris /nsfruiurnf prf /rnrf~fl h~.. ~G
c~
Idilrf•x, Ian G. Park pi( - u,;~'~AU~
PO Box15421 BQOKJ~c PAOf1~
plantation. FI 33318 - ` 1•''.f':;.