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n~ »n MttMwMiCS RAMCO FORM lY0'',
uEN ?~w. rs n~o~
~l~ti~ ~f ~t~n
~att>rdq ~f a t . Lucie
Bofors ms. the undersigned authority. personally appeared ' ' • ~ ...C as S e 1.Inan
who. being duly sworn, says that he is the lienor herein or the agent of the lienor herein,
_ Tropi.~. A.r.. of ..-~t.~... ~~i_erce, Inc .
(lisnor's Name)
whose address is...3.~1.1.-T...~.1E~2'Id.ET' . rsVe . , t_. - Pi-erce, F1. ~3?t~0.. .
(Lienor's Address) .
and that in pursuanceofacontractwith...CLiS.~Oi7 ~OU~121~-. i11C_., _3~G~ ~21teY'pX'1SE Rd. r
fit.,.. F.~~rce,... ~'1........33tkS.~ '
lienor turnished labor, services or materials consisting of: (Describe specially fabricated materials separately)
~nsta? led heating and Air Condit o:~in~.
Copy of ? otce to C ;riser ^.ttacY:ed .
on the following described real property in ,
St ` LiCiP ......................................................County. Florida:
(Describe real property sufficiently for identification, including street and number, if known)
Tot 1`'•, Rik. 1~, Sect. 25 ~
X50 .-.:l. a< layer ~t .
:-t. St. _ uci e, ?l. 33~-~?
owned by J~TfieEl :L'.Z@'r.aT1~.....3~.?...`~e2'i~f'......`Z~.'......ne..'~"'~Sy......~_.'...`j.'........ 7.~.~
i
otatotalvalueot~:r~e._`~housdr..d.-_~~?r~c~-_i~anr?rer.._~...f.f.t~ ? O.LG
dollarslS _ ~,.-5...
of which there remains unpaid S...12~-V.'-~~G for which amount he claims a lien on the above
described real property.
Ne further says that lienor furnished the first of said labor, services or materials on .;.uiy.
~
_ _ , 19~. and the last of the same on... a e.l;~.~ ..2,.......... _ ..19. ~ Q. and (if the lien
is claimed by one not in privity with the owner) that the lienor served his notice to owner on
T`
_.._....~nr........._..........,19..........by
• (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
i
owner on CUWtom..nuW r. .:.nc:....ara~. ~~~....::.t....._uc.ic.. r??:
(Contractor)
(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
~`j~C r ~ (Subcontractor)
on . _ . ........................,19.._._..,by-......._ _ _
(Method of Service?
„
a.w.~C ~J,....V ,~i1.i. ...?/.~...1 .t ~t....l.J..E..~.C lam. ~.L.. a... ,
~/o or
r_... ~ s'~el>~;t Pj~esidert
C~ U
Sworn to and subscribed before me this.....? 7.th..._... '..day o/f%~/_J.q, r. ~!E tY: , 19.E
-•Notary•f
ubkc`.~
Phis I?rslrnr?rrwl pr~y~nrr~~l I?~-: .
Iddrr~.._ H;!r?y Do6fK, Stare of poridi H-[~ .
y ~`~'"~u0° Expires May 8, 1984
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