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rr~ asn racc?ua~cs NRMCO FORM 12o°a
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of Indian Rivpx 1)
Before me, the undersigned authority, personally appeared ......]~QaA1~f:S... - FR • .F~1Q~
. . . . . . . . . '
who, being duly sworn, says that he is the lienor herein a the agent of the lienor herein. .
RE>!ynolds..Painting . & . Decorating . . .
IUsnor's Name)
whose address is 23Q1..I,pon, Avenue, Vero..Bea~chR . _ Flari,cla .32960............:... _ _
Ilienor's Addrsasl ~
and that in pursuance of a contractwith........MX...c'lTK~.MXi3..-C?R.-~.•..Pt=t1C~~. _.29~~.-~~l~.vdi1-...--. _
......Hill. Qourt, Ellicott . City! MazY].ar><d..21043
lienor furnished labor. services or materials consisting oi: (Describe specially fabricated materials separately)
painting and wallpaper installation $1,450.10
Vertical blinds $1,008.00
k
on the following described real property in ~~,Y#~..I+~Cl~ _ _ County, Florida:
(Describe real property sufficiently for identification, including street end number, if known)
QOIdO~DF'S CC~IDONi~IIIM ill, Building 6, Apt. 301,
1140 Bayshore Derive, Fort Pierce, Florida
owned by ~ El.liQO'tt CltY. f~3rylaTld... ~
..........t.~>ed..bY-- --~..~-Mrs,..O.C.__Petridesr r........
100
of a total value of ~..Z'~1Rq.SatDd:.F~AL7X..~h1TK~QC~..F~.tY..l~lq~l~..&...~~ouars (s.... _2.'~`~$.•.9Q. _ _ _ )
of which there remains unpaid S - -2~ 4_$$..90 ............,for which amount he claims a lien on the above
3
described real property-
He further says that lienor furnished the first of said labor, services or materials on .
i
. July.-24 , 19.8Q.., and the last of the same on. ....~tigtist .14._ ,19-80 and (if the lien
~k is claimed by one not in privity with the owner) that the lienor served his notice to owner on lettPX IIi311.P~
August-.15.... - _ . _ ....19.89..... by.......... United _ States .mail . _ _ _ _ . _ _ . _ _ •
(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
owner on..... _ . ..............__...........r1/.A..~......._
(Contractor)
on ,
(Method of Service)
and additionally, elf the lien is claimed by one not in privity with the wbcontractor) that the lienor served a copy
of his notice to owner on - . .
(Subcontractor)
g ~ .
(Method of Service)
~ ttEG L.;- t t . t : l:
• ROGER i::il:R.`.S -~~~~~nt~.:~~.., •
r.: [~:r. cr•i..~.. c:.. ~lI Reyno Painting~iin ting ~v
a~+~3 _ Dolv~res F. Reyrl~dfls ' y:'Q '4 = °
f . ~i' . ~ ~
Sworn to and subscribed before me this _ _ ..............._........day of .....`fig%~ - _ _ ~ •1~'.~ £
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.............:~.M ~ '
States '
Notary Public r _ ,
"1"hip /ns err h f+oT~uY PuKlc StA1E a noRiehc ~Y
'I~S~i~ ~ lca~4 ~ ~
• I rl~/rr~s.• Post Office BOOC 3686, Vero Beach, Fl 32960 MY ca'AMISSION EXPIRES SE*T . 6 19a4
OR tOtr0E0 irUttJ GEf'RiRl1l 1 NS . uNoERwR I TEtS ~
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