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/~A. IN7 LAwe 499416 IIAMGO,011M I:O•
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~l.~~n ~t~n
e.for. me, the undersi~rnd I?. Perms app.ar.d..._..........._ .
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who, being duly swonw, says that he a the lienor herein or ~ ~ # of file lierlor herein,
~ file attorney
(lierlor's Nams)
whose ~ ' ~ ~
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snd that m pssrsuerloa of a oontrsd wrh.-----.. ..d.,..?. .,~,1.~/.......C?..I~!C~.~..
....~'.~..1/.P
~ienor furslisfled labor, servio,s a nlat.rials oorlsistin~ of: (Descrl~e speciaNy fabricated material: separately)
Cis ~
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of s fotat vakn oE----...,/
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of which there remains unpaid i ,,7.~•.s_-o~ . for which amoulr h. claims a lien on the following
desalted nal property in-....~~..~~!..~'/....~ Colulty. Florida-
(asaibe real Property wificiently for identi~ation, indudirg street and nwnber if known)
.1980 SEP 1 S A},• g 51
F1LCC RHC F"C~NI1F0
. SLLUCIf CO!lM1Y.FLA
C ERK CIRC
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COAl1SRi
I or{~Q~p L'~F.7" ~rj._
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Fits •'~ec~P,~"a 1~~y~o~.~3;~r~«
tie G,rtller says Chit kenor fwrlislled file fast of said labor, services or erials on
~y~~~ . 19~~ and the fast of the same on .~.-...!~%~.,Y...... 19~f~ and (if the liul
is dainled by orle not in privity with the owner) that the lierlor served his notice to owner on _ _ -
(Method of Service)
' ' --.-LG........ .
~ gy
Ault or Altomey
' ~S~oorittl~ari~,~~lbed before me the.. day of ~e. .T _......19 ~ G
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'f Lr~:I~utniuncli~ prparr~f by:. No,~ twK a tuouo+? a t~
Addm~ MI apMwss~ON M t~ .
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