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FLA. fN7 LAW! ~~I; RAMCO FORM 1sOM
F• 71~.Oe
~l~ti~n oaf ~t~~
Qefore me, the undersigned authority, Personally appeared .................Raley,,..Cooke.....
• fhe a9enf t
who, bung duly swum, says that he is the lienor herein or ~ the attorney { of the lienor herein,
.......................R~yc..!%nWca_..~.~.._......_.................................._.........................................................................................................................
(Lisnor
s Name) .
whose address is .................P...O....Bax...b~4............................. _ _ ................3.00.. S . E... liaaler ,Avenue
(uenor s Address) -
and that in pursuance of a oontrad wdh......... C~Oke..Conatt~CUC~Io.D..........._
iienor furnished labor, services.or materials oonsistin9 of: (Describe specialty fabricated materials separately) -
?50 gallon tart
200 s4. ft. drainfield -
? yards Rock
100' perforated pipe
200' drainfield cover
Distribution Box
of a total vslue of.a!.ive...Hurxlacad..~hirty..Fite_aud...-.---.------1f(~oNars (i_ ...535-.00-.
of whidr them remains unpaid S -535~~~-- for which amoupt he claims a lien on the fdbwing
described real property in ........................................St..Lucie_..........._....-................_ ..............County, Florida:
(Describe real property suF6dently for identification, indudin9 street and numbef if known) -
Sabrina Lane
Lot 2s 493iZ8s
. stock 2?2 't980 Jl~. 1$ .MI f~ ~T
' section 3 P S-
i
- 'F~ '~aC•R:CORDfp
_ !CD!lMTY.F A.
~ERK~~I~
T
CST
j RTCORD •t2R?FrTD_
owned by......-.
~ Dole.. ~ QZU~~ru~ction--- . . - .
Me further says that fienor furnished the First of said labor, services or materials on-
Affil...21,--------- 19.~Q., and the last of the same on .A~I~1..1........~.~.a......-.--...---...., 1980..-, and (if the lien
~ is chimed by one not in privity with the owner) that the lienor served his notice to owner on
E - -
~ - , tq........., by......_Privity _ _
.
i (Method of Service)
Ray...Cooke's.,~ieptic..Sank..~erxica....._
Lienor
' B ~
. y....... _
ent or,- : yp~, . ij~
_
~
l-
Sworn to and wbsarr~ed beFore me this-........~............ day of ~ p'Q-
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