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r?s an Mrcw?w~ct~ RAMCO FORM 1201'a
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Before me, the undersigned authority. personally appeared ~ll.....4,~•.. - /~~CLtt.~~.4c_(1~?.';~..~..
who, being duly s``w rn..~~says that he is the lienor herein or the agent of the lienor heroin.
(Lienor's Name1
whose address is /.......C~J.X.-.. ~l
~~3...... 4.S.2t~~Pl..........L./(~UQ.1L....' ~ ,
(Lisnoi s Address) 33s~
and that in pursuance of a contract with ~.l.!1't.t~. '
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lienor furnished labor, services /oar materials consisting~{of;)~ (Describe specially fabricated materia~ separately)
~l t.~L.~// LEJ7) / ~ aZJcln?'L,~- (_~'`-~jl'j ' Q
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on the following described real property in.....!!..(,T"~,.~...~Q~....~(,(~(,,~.. ......County, Florida:
IOes`cribe real proper/Jty suJfficiently forjyi~dentification, incl/yudi~n~/g//stre'et/a/nd number, if known)
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owned bY.. ~~..5c:.~-~-GG[.._....J'../,.~'2.G~t,...f.a ..-...r•s3.e.f! ~ t
of a total value of ~,.~,..J.Q ;,"~c. nL1....._ dollars lS 13,.;1~~~::...~~.....? t
of which there remains unpaid S . _ . Y. ,,2..~..... _ ...........,for which amount he claims a lien on the above
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described real property.
IIj He further says that lienor furnished the first of said labor, services or materials on . .
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i yJ~~., . .5... ,19 and the Iasi of the same on_. ~LEaL~....S , 19. c75J .and (if the lien
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is Qclaimed by one not in privity with the ownerl that the lienor/ /served hie notice to owner on .
-~(Lc,~,~... 5 _ . , 19 uj~., by ~ ~ . _~'~:~r..i'..~' ...JLt~4it-M _f't..~t.P.etf ,..,<~..C J'
(Method of Se?vicel ~ ~
and, (if the lien is claimed by one not in privity with the contractor? that the lienor served a copy of his notice to
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` owner on I ~ e( ~t~~Q
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'I vp Contractor) ~~//}j~~,, Q
on ~r!t9'11.~-~ _ ,19.C.Q..,bY-• 1.,/!/Q.c..~....
(Method of Service)
and additionally, (if the lien is claimed by one not in privity with the subcontr(actor) that the lienor served a copy
of his notice to owns FC~ItO~Q ~•z? `„Q~y1'j
~~'~p AMO R , . c IS b , .
ST.LtSC'E' ' ~ l u contractor?
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~ 6 ~ 24 PM +bU (Method of Service)
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- fay..........._ _ ` s„~..~ ~ ~ ~
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Agent _
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Sworn to and subscribed before me this.... f.... .day of ..~Q?.~~..~ ~Qi;'
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~r~ Notary Public '•r,.....,~ '
phis /rr.rlrunr/•nl prry?nrrd I?t-: ~ ' y t~tJKIC S1AtE OF ~
$od~c 3~2. ~S~ 1230 mss
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