HomeMy WebLinkAbout0370 49~~? ~ -
FLA. IN7 LAW RAMCO FORM 1,011
Fe 715.00
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~ Meuctin
BeFore r1fe, the under:grled authority, personally appeared..........~.s1y...~.s~A~rti
who, being duly sworni, says that he is the lielfor herein a the agent of the lienor herein,
the attorney
~a3r.~
flaQka....:..._
(Lienor
s Name)
whose address is-P...O.~.Hax...b~4 .....:........31.OO..S.E....W~aalar..Avenue.....................,
. (lienor s Addreu)
and that in purwarloe of s contrail with--....Gook .Construction ,
lierar famished Tabor, services or materials consisting of: (Describe specially fabricated materials separately)
900 gallon precast septic tank
300 sq. ft. drainfield
10 yards Rock
150' perfoarated pipe
300' drair~ield cover
Distribution Box
of a total value of...seve~--.H~dr~d..S.~cty and. --.--.-.-.-.-.-.-.-NQf~ollars (s-__.760..00... )
of whidl there remains unpaid s --.7-.~Q. Q4 for which amount he claims a lien on the Fdbwirl9
dssuibsd real property in .--.-.St, Lucie-_..--.. ~ ~ ___.County, Florida:
(Desaibe real property sufficiently for identification, indudirl9 street and number if known)
Fort Pierce
S.E. Baxley Road & Bell Avenue
Lot 1 Block 2
~ ~ 8 Att 2T
~uEO ~
st ~ rr. °
' ct.~wc c~i~°n~t
' RECORD \'fRtFl£D.__
Cook Const tion
owned by ................._................z~.......................................................... _
He further says that lienor furnished the First of said labor, services or materials on
AE~~.-~51...~.~~.........., 19........., acid the last of the same onA~~.....--.:..?5......................; 19.50.., and (if the lien
a dairrlsd by one not in privity with the owner) that the lienor served his notice to owner on
t9..._......, by.........Prixity
(Method of Service) -
ktty..G.ooke •.s...Septio...Tank..Ssrviae
<IenOf `1~LStltif:33;3.
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Y s
.
.
Sworn to end subsal'bed before n1e this-.-.....~.~ .........................:.......day of- . ~ic ~ . _ .
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Notary Public -
Notarf? Public, State of Fkxida at Large
%is Ins/rrffnrn~ fn. afrf~l Icy: p' ~1? empires NaY. 28. 1983
• / _ ~t1~ a..ew b Antriw f~~ 6 CsswCy Co.pnr
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