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FLA. IN7 LAWS 491652 Ilr?MQO PORM IfOr
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Before me, the undersigned authority, personally appeared........-Cherlea._.B. Hall
S the aQeM
. who, beep duly sworn, says that he is the lienor herein or t t of the lienor herein,
Diamond Irternetionsl Corporetip..n s
(lienor's Name)
whose ;~.--..~10~_..Oleander-..Avenue.. .Fort,..Piexce.,.-..Florida ..___3450......,
(Lienor : Address)
and that in pursuance of a oontrad with-.....:.... Frank D~-,. Bl'ON11„
...............................................................................................T~ylor...D~iry..Roa~.... PO.s....Box....¢028....Ft,,.Piert:
kenor furnished labor, services or materials colt:istin9 of: (Describe specially fabricated materials separately) ~
Lumber & Building materials as needed Yor residential Construatio
3
i
Five thousand seven hundred seventy sia
of a total valor of ..................&..?9~1.OQdollars (S __.57.76...5.9* _
of whidl there remains unpaid S . --..920..6.0--.-.....__... for which amount he claims a lien on the fdbwinp
described real property in............,Srt......7r(I1C~@............_..........-~ _ ....County, Florida:
(Describe real property wffiderltly for identification, indudiny street and number if known)
.s
491652
Ilot 1 of 106 IInit 9 Tlakewood Perk S/D _
7206 Coquina off Kings Highway. !3~ ~L -2 ~1 2= 37
~.cc a~ r~tx~a o
~ SLLtfLtit' C7.A1TY.f1A.
ROGf.R PtHTRAS
aEP.K CiicCUtT t:0 R7~
Frank D. Brown & H/W
owned by--------------•---......................................-------.............. r
t
Fla further says that lienor Furnished the first of said labor, services or materials on......... 1"80.. $
19.-.--...., and the last of the same on ..-----...._4.:12-80 , 19 ,and (if the lien
€ is dailned by one not in privity with the owner) that the lienor served his notice to owner on - - .
~ -2 ..-80 t9---------. by- nti
t
' - (Method of Service)
.Diamond..-I~ternatonal_.Corporati n
~ u.nor
.....,Charles... B,..--Hall
BY......
Agent or ~r
R
ore me thv.~ :.t. ..............................day of _ .19 .
Sworn to and subscn'bed bef " '
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