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ru tai Mtcw?N~cs• RAMCO FORM 12014
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Before me. the undersigned authority. personally appeared -....:.~..'.e~!f~~..... ~ ~v
............Ni?_..
who, being duly sworn, says that ha is the lienor herein or a agent of the li Mrein...
...A3.....a~. ~.~~,~.,a~......
IUenor's Name1_y
whose address is ...l.r `f.~.,^ .,<~~tr•.R.. i .tr~
.................y
IUenor's Address) y - ~
t
end that in pursuance of a contract with.....~v Y... 5-... ~6N~~'' . •,D 1
,Q
lienor furnished labor. services or materials consisting of: (Describe specially fabricated materials separately)
~aQa~O~ ~o pi4r/.v T .LOt~t/fiC EO ~o2s
on the followin described real ro `
9 P Pe?tyin ................~r...............................................................County, Florida:
(Describe real property suNicisntly for identification, including street and number, if known)
owned by ...................../.~~~'~...CQ...........~~~....................---........................ i
of a total value of f,:~.L..... a~A~?....... ~ -
.........dollars i )
~OL~ 7~i4~_f C~.N~
of which there remains unpaid t..... ~3~~.Q~ 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 ..'s6p
.
, 19~.., and the last of the same on.....?~ ,19-~.0., and (if the lien
is claimed by one not in privity with the owner) that the lienor served his notice to owner on Z .
(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 ---.!./S~~.C.~~ ...........~i''~.retw..il.rt.
(Contractor /
on .................~J~.-..........-..0.~ ~ ,18.4, by------•- - %~.~/".-......~~..~/..~r.......... ,
(Method of Servicel
~ and additionally, (if the lien is claimed by one not in privity with the wbcontractor) that the lienor served s copy
of his notice to owner on .
iSubcontractorl
(Method o/f ^Service)
lienor
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t3y.. 1
t 5058'72 ua~L . , , . 4 . _ _ _ _ }
Sworn to and subscribed before ms this.......-__.~.....-.._..........._..._day of , 1~.
~.~.ix.y'..:...,...........18.d Y.
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This In~fnrnu•nf prr~porr~rl by. - •
E 34z P~~ b ~g _