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4y'1651
IlAMGO IORM t i0 r
rLA. 1N7 t.Awe
F! 7ti.0e
~l~ti~n ~f ~t~~ _ _
~~dq o~ St. Luole
Before me, Ilse tstdersi~rted sufhorilY. P r~ ..............~F~1R.Q.. 8.. ..~1t7..a........................._
sa s that lie is the lienor herein or ~ t # of the lienor harain. .
who. bewt~ duy sworn, y
Di~aomd._~au.~e,.t~,anal..- C.Qr.F~r~~i~a
(lienor's Name)
3103 Oleander Avenue Ft. Pierce, Florida 33450
whose sddreu ' ,
(lienor"s Address)
and that in pursuance of a ooNrad with--.......Gook -ConetZ'.uat ....Roger.._Caok...................__...... - .
liertor ftxnisFted labor, services or materials consisting of: (Oescn~e spedaily fabricated materials separateh?)
Lumber & Building materials as seeded for residential -
Constrnction
Seven thousand nine hundred = ?977~73~
of a total value of ......BeYeat~ seven ~..-73/-i00 ......doNars (i _ - _
of wFiKh thero rema+ns unpaid S .-.12?5.~8 for which anwtu~t he dam a lien on the foQowing
_ .-County, Florida= ~
described real prop+rh a~ .............._........---St~.--- Iructie............................. - -
(Describe reel property wf6ciedly for identification, indudirtQ street and number iF known)
Lot 1 blk 1 Raintree S/D
t9E~ -2 t'~ 2~ 37
FIIE~ ekf s, COl4uf D
St. UC>E CGU!(TY.Ft A.
ROGER POITftaS
- Ct.~t CfRCU1T COiltT
491651
.Roger... Cook . &...o.~ . Co.4~C...Comst?~''ti~t~..QA.-..._
Owned by-...---~---.......----- - .
He further says that lianor fumishad the first of said labor, services or materials on--~
-.1.2- .__..._----......,19.?.9.., and the Isst of the same on -----.•4-@G-----._ 19 - . and (if the lien
is dawned by one not in privity with the owner) that the lienor served his notice to owner on _
.
(Method of Serv'~ce)
Diamond International Corporati n
lienor
C.B. Hall
y -
A9eM or Attorney
me ...~--..........day o . _ .
Sworn b and wbscrt~ed before t~. f .19.
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t' 334 Pace 861
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