HomeMy WebLinkAbout0715 a95~s~7
)U 117) MECNAwIC1' ARMCO FOAM 120 by
urw u?w )s Hera
~l~im ~t~en
~ ~
Before ms, tM undersigned authority, personally appeared~F~~•S.. _
who, being duly sworn, says that M is tM fienor herein the agent of tlae lierwr herein....... _ .
1 's Ifan+el
whose addressis........(~~!/..../.•./. G. .~W...S..I.r,..----l.T., ~/a.. ~I.S~
(Uenor's Address) ~
and that in pursuance of a contract with .....~v~a. -!./~-/~<.Q - _ _ . _ _ ,
lienor furnished labor, se~~rvic~~""es or materials consisting of: (Describe specialty fabricated materials separately)
on the following described real property in ` U G q, Flonda-
- - - --Coon
(Osscribe real j'roperty wfficiently for identification, including street and number, if known)
~/So ~jivo~/.r ifs: LD~J
~ ,e~/1~. Z~v, !JN• ~3 ~t:,e, g0~ -
~vb/~ ~ /'eCo~S D~ Sf • •Cvr?~E CDv , ~~Q. 33S<.~a
y
otatotalvalueof - f~` t, ~ -..-dollars):----- - _
of which there remains unpaid s r-~ fw which amount he claims a lien on the above
described real property.
He further says that lienor furnished tt)e first of said bbor, services a materials on ~ . .r~ifr"
f r ~
3 V ~ 1....... ,19.-....0, and the last of the same on---,w9-.... ---1...... t9.-~Q.. and the tien
is claimed by one not in privity with the owner) that the lisrwr served his notice to owner qa
I '
i
(Method of Service)
~ and, (if the lien is claimed by one not in priviq with the contractor) tfaat the lienor served a copy of his notice to
I owner on
(Contractori
(Method of Service)
and additionally, (if the lien is chimed by one not in privity with the wbcontrsctor) that the lienor served s Dopy
x
of his notice to owner on
4 9535'7 (Subcontractor) -
r. -
_ ~ .
o (Mettaod o~ - -
_ _
~9~ AUG -6 Psi ~ 33 S' ~~e~' _ = ~
hC COnO£D Lreray~ ~
EE
' R06ER POtTR,4S l
j CIERlIClRCUITCa~~i BY - - - ..i~.
- :6 = i
Sworn to and subscribed before ms this.-- - _ .-.-....----__.day of . --n_K,R._. i9~ .
~ otary Public
%•lris lrlslnrnlr•)rl prr•pnrr•d ha: wOTARy HtAtK STAiE OF lilD~/W1 N yes i
I rlrlrr•.c. W GOMW SSION fiX/IRfS Mlle. M Nlt~
X336 7i3
/~~3
_ - -
. " . _
w