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ru? MEtw?wiCS• RAMCO FORM 120?'+ - '
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Before me. the undersigned authority. personally appeared
who, being duly sworn, says that he is the lienor herein or the agent of the lienor herein,
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. ~'~+'G....~M!..t!~ifi/..~~.5.... /.lr.~!!.~/ I,?r!! 4~-f.Ct~ ...fa!Q.. ..!r!r.,~I.3... / ..~~~i1~I. I
(Usnor's Namsl
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whose address is.~~J~./f~......VAe.~.t'O!~....~~~~...~7.. .~r~~4~y..1...~1~?~...~-~Y~Q... ~
(lienor s Address)
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and that in pursuance of a contract with.....~....~fS.~Q?•?......./.1.Q..i~.FI..!S1 . . z
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lienor fumished labor, services or materials consisting oi~Describe specially fabricated materials separately)
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,~ow. _~D Aim. - :SD, oo ~
~ysf ~i~~~~ ~ - 6 9d.
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on the following described r4al property in County, Florida:
(Describe real property aufficientty for identification, including street and number, if known)
~A wry A•~•l<<ss ~~~~~,~,.y~-~s, ~o ~,ve~sE, ~~a A J~
owned by......-.---- / . ` ~ J>/ ~ t/
of a total value o~~~!.~!~~!!~~~F~!1.~~~?~-.~>~E•,~O...v-.-.-dollars (S .~I-.,9-.-.~~-....)
of which there remains unpaid 5.......~/~/~~••---•••••-•-••••--•••••••. 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
,19..-......., and the last of the same on....................---------.......... , 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 }
_ _
------•-•-----•,19.........., by . s
(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
(Contractor)
on------- . . 79........... by...........................---...---...----...---.........-................ ,
(Method of Service)
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 ~'~~...,~,uT,~~~.l1.,~lr" /'V~!~!V.S.A!J...Q~...~G.:.. ~~~j~1~.!:!.
(Subcontractor) -
on........... , 79.4...... by.. .~../.!!~--5 ...S~.tJ........-../~V. /.!V... .
/ (Method of Service?
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130 Or,~ 2 ~ ~l: 19 _ ,Q ~ ~~a,~~,~
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i?Lfi' eAi `i ~Cdufll 50412'7. ~n~ ~ienor r ~ ~t~..~.,r~~~•
SLLUCIf C(:(,lV.Y.f: n. ~ ~;'a:'--''
ROGER F'vlTR,SS - _ :7it:i,~: `~.ti,}, . .r y
CLEPK CIR~~JIT CC1.R By .................~.~..~.~~~.....r~ i i,-~
s p ~ Agent - ,G it;: r s
Sworn to and subscribed before me this....--_....~~........._..-_...day of ....~.{~,1/'~°I.~..........' a'i,,.~Jj
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- Notary Public
lYti~ Inslrunuvrt prr•parrvl hy: ~ f~K RAC of ~t I~t
.•tih/rrss •?r ODMNUSSiGn l171?t1~S ANR. It N~~
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