HomeMy WebLinkAbout1775 ~4Q7U 1~4 ~
FLA. 1N7 LAWS IIAMOO FORM lee•
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~l~ti~n ~t~rt .
e.for. m., tf» urldersi~ned authority, p.nonaA~ appear.d
. the sQent t 4
w~l-q-.-bem~"'duly sworn,, says that he ~ the lienor herein or # tM attorney S of the lienor herein,
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(liellor's Name) -
whose addreu is_....~.~.1.1........~._...~.~..~.~ ,
(lienor s Addreu)
and thsf in pllrsuarloa of a contrail with......... ~1'V!~?..... ......C~.............................,
lierwr furnished labor, services or materials aonsistin9 ef: (Describe specially Fabricated materials separately)
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of a total value of .`.'~!?!!1\..................._.~ddlan (i .V. 1...
2Cj b
of which there remains unpaid - -{,J-.--l ~ - - ~ - for w amount he claims a lien on the fdbwin~
described real property in.--- ......_..County, Fbrida:
(Describe real property suFFiciently for identi ion: in~cll,ed'snQ street and number iF known)
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E R=C~rA l'ER1r I{t?_
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Owned by-----..
He further says that (ienor Furnished the first of said labor(, s~ervic~es or materials on--- ~ ~
19.~ and the last of the same on .\"1.'!'~'"•..~ ~ 19.. Q~ and (if the lien
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is dairrled by one not in privity with the owner) that the lienor served his notice to owner on -
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(Method of Service)
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Agent or Atforney_c . ~
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Sworn to and subscribed before me this . day of _ . = C '
.~-....'1c~n~c-~-~c.......... ~
Notary Public _
%is !uslnian-a~ 1?rrlnirr•,1 STATE of rtrul~tW? Ai tM~i~ ~ .
/~IpTAtr wK.~c h trust ~`l,