HomeMy WebLinkAbout0631 495' 9 /
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ru? ~~77 MECNAN~cs• RAMCO FORM t205i
UEN UW. it 71701
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flstoreme, the undersigned authority.personally appeared.....Pfttrl~a~a~~~Pete-re
who, being duly sworn, says that he is the lienor herein or the agent of the lienor herein .
Huber Plumbic
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(Lienor's Name)
whose address is......30.3...H.,.•.25th-•gt.,....Fort-• Flerae•;•--Florid.a
Ilisnor's Address)
and that in pursuance of a contract with........£p~be.~~-B-•~Reti9tHU-r6t2'i.~i .
lienor furnished labor, services or materials consisting of: (Describe. specially fabricated materials separately)
Installed new hot water circulating pump .
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on the following described real property in $t.....LuC.j,@ County, Florida:
(Describe real property sufficiently for identification, including street and number, ii known)
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The ~.mber s Rest urant ,
1812 S. U. S. Highway # 1
Fort Pierce, Florida
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owned by....----...~'~x'~~.. Q.. a..~i.P.ItlP~2'I.y.--•
of a total value of 2'-M?O.-hUY1d.I"ed.. A.2'id.-- tTe1e2:Ety.. (~O~.a.AI'S......... dollars -.22G...QO `
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of which there remains unpaid S ----..220.00 ..,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
........I:ay---....---.1-Oth.19..80--• and the last of the same on..........-14ay..-1~O~th••- - ..19- and (if the lien
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is claimed by one not in privity with the owner) that the lienor served his notice to owner on
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...~'.ay.---].nth-----........19.80--., by..........~:ai~l.........---•-••---•-• .
(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
t owner on
(Contractor)
-~-t.. -...19..........,b
on y...............--------•- ,
(Method of Service)
i and additionally, (if the lien is claimed by one not in privity with the subcontractor) that the lienor served a copy
of his notice to owner on . r
(Subcontractor)
CEO aU~ -6 AN 11~ 47 • ~r~;,.;.. - ;
Method o~~~d~• - '
• I'ILEO LNG FECt3R0E0 - - - -
SLIUCIECAUM1Y,FtA. ~ - ~
ROGER POITRAS ~ ~ (-745~~' . '1
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CLERK CIRCUIT COUR ..:..t.:.~i. ~ r.,... -
PECCR~ 1'EQlFtEfl_._~ V a "t''. ;r~,'; ~ _ I
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495294 f3y....._ .
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) Agent 'r :,i•;.''
Sworn to and subscribed before me this ....................t~Y.-.--...............day of ~f~C G~c!.L.,~-.........,..... _ ...18..
otary Public
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