HomeMy WebLinkAbout1165 _
4g3'~'65 ~ ~ - -
ru? gar ~tcwwecs• RAMCO fORM 12oYi
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Befor~ me. tM undersigned eutho?ity, personally appea?ed ...~~.11..~'~... ~.....~.U.~e:.
who, being duly sworn, says that he is the lienor herNn or the peM of the lienor herein.
(lienor's Name)
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whose address is . u.~...7..~ 7..... ~ ~~-.A N J..... ~V. A. ~.....t...OR..~"...~'~ ~.u ~.!.E.. ~fURI~?_A.... 33. ~s_ .c~.
IUenor's Address)
and that in pursuance of • contract with N1.1~-.....K~. tir....`.~ ...~.r.S....'.J.~1ut
bG?:c.rti,....~(.N.~. ,
lienor furnished labor, services or materials consisting oi: (Describe specially fabricated materials separately)
'
Y ; o > I ~\o ~ ~1r ~M c,.ken ~ S s C~ s-1- r C-1' ~ o ~
on the following described real property in....~~.....~V.4:}.'Q:- .................................................County, Florida:
(Describe real property wfficisntly for identification, including street and number, i1 known)
?sao S.~- . C-f?vv„p,.~K1~ - ~r~+v~. ~.~f is
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owned b li ~ jo.... V.~'.`.!r'.f!~.......1~: f'T ~ v (i ~
y..........
S ~~n ~tl~~,rs ~~/'Jfsollar:ls
']'7~f ice'
of a total value of .~'JQ h Af1~~ SeYe~-~ -~f -
of which there remains unpaid s •7 ~ ~ . , a
...............................for which amount he claims a lien on the above
described real property.
He further says that lienor furnished the first of said labor, services or materials on
~
f J.Cl.klU.~..!(:' - 18.~.., and the last of the same on.(YJ.1.1.~---...~'.~............,18..5.11, and lif the lien
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is claimed by one not in privity with the owner) that the lienor served his notice to owner o ~ N-~..~.. ~../r..B~3
.
..............,18.48..:.., by...~~.T/ il/.L-...~~~. ~5-~-~.r.~Sk-...McA:t.........----....................... ~
~ Method of Service)
and, (if the lien is claimed by one not in privity with the contractor) that the lienor served a copy of his notice to
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owner on ...~U. N.f....~..~..~.C~.v
~ ~ - , (Contractor) / /
(Method of Service)
and additionally, (;`t th! lien is claimed by one not in privily with the wbcontrsctor) that the lienor served a copy
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of his notice to owner on
-
493"65 (Subcontractor)
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19~0-:~--73- -1~- 57 (Method of Service)
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.r_ : i ~ Sv??~g~p.~fl subscribed before me this •--•----•.---..--.-•..day of
~ ~~-r.~, ~ .L i c~?'oR- N Public
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s~}~~~~ NpTl1tT /WLK STATE OT ita0iU0~? AT I/~+r
""•,a+n,,,...~y. M~ GOMMISS.ON EXII~.
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