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ru- 1177 Mttw-KICt ~ RAMCO FORM 120~'i
urrr u-w. rs n~a
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r ~ ~~
of St . Lucie
Before ms, the undersigned authority, personally appeared .....P.f»ir.eX ..A.. .~Qge.T~ S., ...v~.f:.e...P.Te.S.....
who, being duly sworn, says that he is the lienor herein or the agent of the lienor herein. ............................
... _ ................The...B.etham..Group.,...lac....................................:...................
(lienw's Name)
whose address is......732..N. E.,_.. Cotmuer~ial,..Street.,...Jensen...Beach,_._FL.._334.57.._
(Lisnor's Address)
and that in pursuance of a contract with ............. ~ ....&..Mrs ....Irving.. Ray... Thomas
lienor furnished labor, services or materials consisting of: (Describe specially fabricated materials separately)
Certified Boundary Survey, Percolation Test and Preparation
Of Application for Septic Tank Permit.
on the following described real property in ....... S t......~.UC.a,!< .....................................................County, Florida:
(Describe real property sufficiently for identification, including street and number, if known)
Lot 20, Block 62 of Indian River Estates Unit Eight as
recorded in Plat Book 10, Page 73, Public records of St.
Lucie County, Florida.
owned by.Mr.... &...Mrs .....Irving--Ray...Thoma.~ .......................... .
of a total vah,e of .. One. _H.undre.d . Ninety....and ..0.0 x.1.00.. ..dollars (s 190 ..00 . ........... ......1
', of which there remains unpaid S . 19. Q.+.D.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 . NOV . 11, 19$0
_. , 19 ... _..., and the last of the same on NOVember _19., _ .. , 19_.$0., and (ii the lien
is claimed by one not in privity with the owner) that the lienor served his notice to owner on .... ..... ........ .
.N/A........... ,t9. ....,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
owner on ._ N/A.__.... . ............. _..._. ....._......___.. __ _ . .. ..................... _ .._ .
(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 N~A... _ _ .. - - _. _ _ _ .. _ _ _ . .
(Subcontractor)
i on ~ggp pEG -8- -P~t- 3~ 53 , , 9.. . , by _ -
(Method of Service)
filEQ ~tiC F'COFC~FD
ST.LIICIL000YTY.ftA. - '
ROGER POITRAS n . Ttl~ Bett1S Group, . InC .
CLERK CIRCUIT CCJitT !~
I nor
5t)96s1 By _ _ _ _ ...... f
Aae
Sworn to and subscribed before me this. .._ ~1f tkl..__ day of
~Tiv".Y PLe.{C Slti~ !k F";?1^1 AT t/1RC,t
fAY CG.:,MIS~!G:t Cis: _~ I LY 4 1Y33 C
~`i1:cU Ir.w~ (,.:.cn:.: lira, (~:.:itXrrKl-t2s
'I'bix Irlanlr-tr•rrl prr•parrvl h~~: Connie Caputo
Irlrlrr•x~ 732 N.E. Commerci treet, Jens~a
4 p,~il~
~~
__
• r.f<,r.~T~'.• V•
~p ,457
OF FLO Z~~?
19 $0