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THIS INSTRUINENT PREPARED ~Yr; ~ l
FORM 1S7 Claim q/' Lielt [
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$t11te of FLORIDA
(Qowttg Of ST. LUCIE ~
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BEFORE ME, the undersigned authority, personolly appeared ...~.K..~iF~'~~LFa..R~:R~~l~4JC~~
of DESIGN CARPET AND FLOOR COVERING CORPORATION who
.
being duly sworn, says that he is (the lienor herein) (tke{agent}{~ttesmry~-vfthel~ie~terein)
whose address is ....112•. Angle„ Road.~,• Fort„Pierce,t„Florida 33450
..........................................................................................................1~Q . SEP..~ 4... ~
fILED RA'C FfCWiGEO
and that in pursuance of a contract with ....rSliA~3(?1`I .lIR1~F~ j~~4 .......Sf:L11S1E•Cp~?fY.~t1t;
S()() ROGER POItRaS
CLERK CIRCUIT CQURi
......................................................................................................MCCE'L?Yi~,l..r~.....
lienor furnished labor, services or materials consisting of ..~Tjg~a~.~d~.~,GA..f?~...~d1~i~:~~ r...S~~~~~~
sand, 12 x.78 (104 yds.); wall-to-wall, on 1/2" Rebond padding, and
installed in kitchen GAF X27625, 9 x 10 (10 yds.) (carpeting & vinyl).
(Describe specially fabricated materials separately)
on the following described real property in ............~qrt „S~,t,• Luc~,,.__$t . L~cie,,,,,,,,,,,,,,,,,,,,,
County, Florida 567...N....Wr..i~Z~~e..Avg:.....~'4~'~..$~.t..~R~~~....F:~e..33452
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~ also described as Lot 4, Block 114,. Section 27, Port St. Lucie,
c Florida,
(Describe property su~icierrtly for identification and give street address if available)
owned by WAYNE.•ERrCKSON t. Rt.•• 11 Box _ 251A,,, Robards t___KY 42452 _
of a total value of :.962.10 of which there remains unpaid :..962..10 ~
and furnished the first of the same on .........August•,11 1980 and the last of the
same on ..........August 12, ~ jg, 80... and (if the lien is claimed by one not in privity
with the owner) that the lienor served his rwtice to owner on September.,.. 3.,,,,.,,,, jg, 80 by
(here describe method of sen;iee of notice) .certified mail, return receipt
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.........................................................................DES'I~ ..C1s?RP ..S..FI.bOir'L"'rJVER 'OORPO
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~ Lienor
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Sworn to and subscribed before me this......g... of.. Sep, -
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My Commission exp~irea,~?ruSSltK:! ~!~'~:;F ' ~ _ ',0 ~ '
rl ~ ',rt INS ~ V~~~?:~.i~~i a ~ ~{~•~~~J/~~ ~ t.;`~: - .l
MIDSTATE LEGAL ~r1PPLY COMPANY pr,A~~LLy P~ ~5 Y . '
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