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t~Cl~~m ~f ~t~n
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°elore ma, tM undersisned authority. personally appeared ~C./ I ~~C y C - ~ /P/''
who. beino duly sworn. nays that ha is tM liena.herein a the anent of tM liens herein.
Illenor's Namel
whose address b /?(Il.C ~ ~Q~ ~
C. Itlenor's AddrasslQ
and that Ir! purswnoe of a oontraot with ~ It'.~ /..S a / P ~ S ~,S -r/tC .
~ ~ ~~r ~ I,j~ / T/`• Sic i ~Gf~ SQ' t~a 3 dJ'~ ~ /~j(ca.
lienor IurnisMd labor. servloes or materials oonsistin~ ol: IDescriM etiecfally isbrketed materials saparstalyl 1
S ~ y, ..9 ~ ~ a s s e s o ~c. h ~ ,6~ ~ r~ .rJe
• F
i
f
on tM following deseMbed red property In .JJ~ ,d' k er' e e ff County. Florida:
(Describe real property sufllclently for Identifloetion. Inciudinp street and numMr. it known)
/t n /s ~ s>frrc w i~v7 d ~ 7` e ~ ~ v ~s 7 ~
5 n r. s t~ Ttb r r c' e
/ ~r n S : J s F~ c p , /rte A ~ 3 y~ 0 .
~
owned by ~ / /
dY CY /l ~u ~ ic/ Q 5
O
of • total value of ~ C . dollars ! ~ 1
of which there nmaine unpaid i ~ • .for which amount ha claims a lion on the above
- s
described real property.
He further says that lienor furnished the lint of said labor, sorvices or matbriNs on /,~1~- ~i
~j t
. 1 Y and the last of the ume on d ~ ~ y , t9 f14j, pnd (if the lion
P '
le clalmed.by one not in privity with the owner) that the lienor served his notice to owner on
.10 .by
- (Method of Sewicei
and, (il the lien is olslmed by one not In privity with the oontraotor) that the lienor served • copy of his notice to
owner on
(Contraotor)
on ,.17!_ , by _ . _ .
(Method of Service)
and addlllonally, III the lien le oleimed by one not in privity with the subcontractor) that the lienor served s copy
of hie notice to owner on 4~~~'s+W
I lfuboontractorl
on _ ..1 . by
t ,...1~~,~,} ~oY JU~ 22 ~ 4t 48 (Method of S rvice) C
7. . r >iT ~~OITRA ~ ~ lienor
' Ct CIRCUIT C~i ~ .I
~ : Rt~npnvrplrlin.. - °y ~ ~f
~ ''~~ttilii+rt~o i~itds~lbsorlbed before ma this ~ day.ol~-t F~a 19 ~ D ;
,/,fig. -
c , a 'i~'s3`C C lClt~~~ s
~ - tart' Public ~
~~~1 h1 ~ll •I / ll /111'!11 ~II'I'~11111'l~ ~11 : IgiAAt 1{Iklt StAi1 W 11t,Il1aA N t,A~'~i
E Illlllr~~r~ rr co,ww>,~~oN wlus itiA~. 1~ Na , ~3
~ir I~VS ~dUE p"°i° tldMl awaK 1i1~ . unorlwa~l ~ ~ '