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ilA 1177 MECNANiCf" ~ A RAMCO FORM 120'x,
?IEN ?AW. it ,I~Ot
~l~ttllt t~Yt
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~ St. '_-uice
Before me, the underti ned authorit ersonall a S T~ - C~~ S E lmari ~ -
9 Y. P Y PPearsd ~ •
who. being duly sworn, says that hs is the lienor herein or the agent of the lienor herein,
~'rop c..:~~.r...of...?'~.•...~'ie-rce.?....Trc-.-..
(Lienor's Name)
whose address is...3.1.}1-~_--Cle~nder .ve.-,.. Ft-.-..Fierce,. ..~'~.~...._~.3.?~5~...........
(lienor's Address)
and that in pursuance of a contract with rUS'tGIa ~;OL1S lYlg . TT2C-....33.06 i ntE rDrl~.P Rd , _ _ ,
_-,-rt. Pierce,- --Fl. 4 0
.........~.3....5......................_. _ . _
lienor furnished labor, services ar materials consisting of: (Describe soecially fabricated ?naterials separately?
T^stalled heating Fc Air Conditioning system,
copy o~ notice to oK~ner attached.
g P P y St LLiCi e ...............County, Florida:
on the followin described real ro ert in •
(Describe real property sufficiently for identification, including street and number, if known)
mot 10, ilk. 1j06, sec. 29
.'-312 S . county Ave .
Ft. Wit. ~uC? P., ?l. 3JlyjL
owned byi,:Gr'~ Carol--F;eirsber.E...2~CG.-~_adispr...S .tuzrt.,....Fl....._3.~~94
ofatotalvalueof.~"e....il:ou~ar_d give ~:undred---------- 1 ~C.OG
of which there remains unpaid S-.. ~.~~L-~-'.4~------ - - for which amount he claims a lien on the above
described real property. .
j He further says that lienor furnished the first of said labor, services or materials on j; pz,J.(3;j';~ ~ .
i
f , 19..~C.., and the last of the same on.... 1~ _ , 19 ~.C._, and lif 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
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:OV.'...x......_......_.....,19"J....,b i. t.57i.
y
(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._~UStO:~. ::auslr~ ;:^c. ar:d Suburban Coact2?--.-_
g
r (Contractor)
E on GV. S ..............193G ..by..-..........-....L.- ::511
( (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 . .
~ (Subcontractor) .
so~sss
~ on.__...._.. ..........................._...._....,19..........by........._._............
s (Method of Service)
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By ~r~.....C~......- . .
. _ ~ ~ nge~t
S. i,'. Casse~:rtl~a7S, :'~~sider_t
~ Sworn to and subscribed before me this _ ......L7.t~''a_._. _day of ...I,O ~ ~ .3~A J~ ?.~~1
j. _ _......19~
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Tlrir In~lrrrrrr~•rr~ pr,•pnr,~?! br: ~ ; ; , p ~
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• Mo!ary Pub)It. Stale of Florida ~:li r•.,
- lI~3~3 i :t<<:
BG~!( PjGf fey C~rnrr.issi~n Eza:res May 8. tYS+?,:.-~ x ~Stt ' -
E.n_e• inN t~n• i•.w .wrnpc• IK.
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