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RAMCO FORM 120Nr f
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8sfore me. the undersisned authority. personally appeared ....X~1T.E1~•-~~~ j
who. being duly sworn, says that he is the lienor herNn or the agent of the lienor herein..
.......................................k'I1~.SITL.AISPRIHLtI~ORS.,..SNO................................-........-----....---...............---.....
hiersor's Name)
751-I Pinetx+ee Drive-Indian Ha~ta~r Beach. Brevard, Florida.......----•- • •
whose address is
Ilienor's Address)
Fit~HIC IEi'S Q'~TliiJGTICN
and that in pursuance of a contract with .
lienor furnished labor, services a materials consisting of: (Describe specially fabricated materials separately
IT~TAZI,ATICN OF ?04 9Qi~F~E Ff~T OF Fd;QJIAR DRIFT S'•PGL`b.
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ST. I1JC~.E ...County, Florida:
on the following described real property in
(Describe real property sufficiently for identification, including street and number, if known)
25th street-semiiyole s~ringt Project
Ft. Pierce, ST. IIJCIE, Florida
FRAT~IIC I~'I4iCN1~S tx',[~15TRIICI'ION
own by
of a total value of Ztao-'~?~sand••six-hundred,_forty..and• nojlAO-~Ilars IS 2640.OQ
of which there remains unpaid 5..26~l0-.1)0•••••-••-•••-•••••••••••••••••••-• forwhich 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
~ Deoeanber 6 , 79 ~
,19.........., end the last of the same on...-..........---............---•---••- . t9.........., and lif the lien f
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is claimed by one not in privity with tha owner) that the lienor served his notice to owner on
~ _ _ Mard?..19.r .................19.x...-. by--.-.-.....~-S,--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
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owner on
(Contractor)
.........................19.........., by................
on .
(Method of Service)
and additionally, lif the lien is claimed by ane not in privity with the subcontractor) that the lienor served a copy
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of his notice to owner on _ _
(Subcontractor)
~~35'714
.........19........... by...-•--•-------------
i _
J•+~ ? 3' (111(ethod of Service)
f~tlEf ' • is F-~4~~c G _-.-FIT:~SIIE• DIS'TftIHIJPORSr...INC.
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Sworn to and subscribed before ms this.._.~~ ~
he cu? F~~l;c.::aie cl F'.ori~a at targa ~ - '
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1~i1y Coaw~iss'ron Fzpires M:?cfi 6, 1984 • • - ° • • - -
b.ua iu. i,a7 fa~~ Iasrra•n inc. • Notarl.. ublic
This /nsfrumrnf- prepnr~d b~•: • .
Katherine Mreye~ ~ -
Addre~ss _ ;
751-I Pinet.nee Drive, Indian Harbour Beadz, Fl. ~ •