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514003
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Beforeme,theundsrsignedauthority.personall~eppeared.G~1!~.. ~OSSt Liuhtlna '.;et~ter~ jriC I
who, being duly sworn, says that he is ths lienor he~ein or the agent of ths lie~or harein, ... ...... .... .... ......... . .
. ~old ~oast._ Lia~ht_inc~_ .~entPr~_ ,.Src.., . . ~
... . . . .
(lienor's Name) ,
whoseadaressis.. . 1.004_ _Sout~n._ 4th__ Street.!_ .._Fort. Fi.er~e ~.Fl~r.ida 3~4_~J . :
~ (Lienor's Address) .
and that in pursuance of s contract with..:=usto~ ,:~ous inQ _ Syst_e~s ~.Inc . :
................ ... ...
~306 ~~nterprise_..~d._,__. _Fort .PiPrce_,.__Florid~ ~34~0
. ...... . ... ... . . . . . . ,
lienor turnished labo~, services or materials consisting of: (Describe specially fabricated materials separately)
Lightinac Fixtures and supplies
on the (ollowing described real propert~r in .............~.~.~...~UC ~e.. ............---.......... .. .... ...... . County. Florida:
(Describe real property suificiently for identification, i~cluding street and number, if known)
772 ~.W. Grer.ada Street
Port St. Lucie~ Flor~da
L~t 10, 31ock 54, ~ectior_ 25
ownedby---;=r:...Ar~ire~. rolnick ....... . .... ......
...... .............. ........ .. ...... . .... . ............... .. .. .
ot a totai vaiue ot . Seven T'.undred F ~.f ty- sevQn ,~ 62~1 ~0 _ dollars (S ..? S.7 • F~ _.. ..... 1
of which there remains unpaid 5...7.57..'-~.~ ... ..................... ior which amount he claims a lien on the above
described real property. '
He further says that lie~or furnished ths first of ssid labor; services or materials on ........ ......... .. .
`:o~~em~er_ 3rd ,.,~9. ~~... and the Iast ot the same on. "TOye~~er.. _~rd.,.... ,~g_ P.O. , and (ii ~he Iien
is claimed by one not in privity with the owner) thst the lienor served his notice to owner on . ... ... ..
J~!^.u~.Ty....~t:'2 ~ - ~-- ~.19...~.~.. by......-- . . ~'!~.i ~..... ........................................................ ........................... .
(Method oi 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
...................
~'usto~..Jovs .~. ~Y . ........I.._ . ~ ..... ... ........ ...___. ...... . ..... .. . _.
owneron...'~ - --- ~-~~-- -t~-- --~ ~12'I J .SteP1s riC. .........
(Contractor)
o~.Jan~aarv...9t~?.. ..........................................19p-~---~.by..r!aS.~.-~- - ............. .......----.... ... ~ .... .......,
(Method ot Service)
and additionall~, (it the lien is claimed by one not in privity with the subcontractor) thet the lienor served a copy
of his notice to owner on .......... . .......... . .. • .... ............ .........-....^-........ ...._....... .. ... . - .. . .. .
' • (Subcontractor)
......... ... . .. .
on ...-- - ......._ . .. - - - ...... . ... .......19--........b~ ............... - .- -......... . .... ... ..- ._...............
,~8t .~;~i'~ ~ s .~l~ j f; ~ S (Method of Service)
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514003
Sworn to and subscribed befors me this ..... ......... ..~~o~ ~. ....
7his liislrunu•n~ pr~ pnr~•d h--:
:1 ddr~•sr $110K •.)~~ P~6f f.-~~
ao~d...~east...~.,.~a!~t.i.r.~.. ~.~ente.~......Ix~c....
lien r
B ............. ~.. ...~ _ . . ........ .... ;, •~: ~
A `,-.
hn 3. Guettl~r t ~lice~.~s~jt
. .,~ ~
.. .. aaY or . ......... .......... .. JA•~~ ~.~_r.'-,;'--r':.~?. :; ~,.
` : ;~ ~s-<_~~'~~~~; ~ =
.. .. . .... .1~!~~a ~.~...`~-. ...~ = : - =O •~ ~~~ . ':
Y Notsry Pub11C_ ,=:~9 'rr ~ ~~` ~
s ~~f~'•d~~~'~,~ .
Notary Pub~~c. State ot Florida t~ll~1~,(1.;~,,~' ~~
My Comm~ssion Exp-~es May 0~~;;; ;•. ,.
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