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514233
nw »~i MECNwN~cr RAMCO FORM 120'h
UEM lAW If 7q0~ ~
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~o,mtq of Brevard
Beto~e me. the undersigned autho~ity, personally appeared .. ._ C d 1" ~ J o h n s A g e n t
.... .. . . . _.
who, being duly sworn, says that he is the lieno~ he~ein or the agent of the lie~or herein, .. ... .. ... ... ....
Climatrol Sales Inc
. .... .. . . . . . _.. .... ... . . . .
(Lienor's Name) .
whoseaddressis 529 S I11duSt1"y RoBd COCOd~ F1o1~~dd 32922
.... .. ... ... ... . ........... .. . . . .. . .. . .. . .. .
(Lienor's Address)
and that in pursuance of a contract with ....... J d 111 @ S M1 ~ ~ b U 1" L d W .
.. .... . .. . .. . . t
218 Beach Avenue Pt St Lucie, FL ~ •
.. .. . .... . .. .. . ...._ . ... . ,
lienor turnished labor, services or materials consisting of: (Describe specielly fabricated mate~iats separately)
Fabrication and installtion of screen pool enclosure
St Lucie .
on the following described ~eal property in ...... . ...... . . ... ............. .. ......... County, Florida:
(Describe real property sufficiently for identification, including street and number, if known)
.
218 Beach Avenue Pt StLucie, FL
also known as Lot 1& 2 Block 9 River Park S/D dnit 1
James Wilbur Law
owned by .. . .... . ..... ......
.... . .. . ... ... ....... ....... ..
~ otatota~va~ueof. F01'ty-one.hundred 4100.00 j
... .. . dollars (S . .
of which there ~emains unpaid S. . 2 7 3O . ~ ~ , for which amount he clsims a lien on the above
described real property.
He further says that lienor furnished the first oi said labor, services or mate-ials on .
~ , 19.. ... , and the last of the same on , 19 . , and (if the lien
is claimed by one not in privity with the ownerl that the lienor served his notice to owner on
.
~ _ . ,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 ot his notice to
, •
owner on
(Contrector)
on . . . _ . 19. _. .., by.. •
' (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
i
. on
i
5~4~93
4~~i J;+~ 20 :~~ tl; ~$
FIL'_C ~ht "• CaROE~
« t ~~r~t rt+~~r~r. f! .
__.. .- f'l,li"..' ~
. .' ' • V ~
(Subcont~actor)
, by
(Method of Service) ~
Climatrol Sales Inc
_. .. ._ . .. _ . . .. . ..
/ . e or , •
. . B,~C ~ . .. u,,~
~ y - " ~; -- Agent ~
1 , - . ,:
( Swpr~ tt~arnd subscRibBd before ms this ~ 5 day o ~ a n a u a ry _ ~~ ~
. ~:;- ;, ~ ..• ~; .
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'~:,' •.......'- r, ;~` Notary Public
'I Yri.,1r~..~ i g~r~.•h-,~irr~~-nri~~tli ~~: ' C d r 1 J O h n S
1~1~1~.~;•~ •:~~~~"~'~ c~~ 529 S Industry Roa
~ B~iK347 PA~E JIjV Cocoa , F1 ori da 32922
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NOTARY PUBUC STATE OF FL09tD.A /1T Lw'~11q~~ r
MY CO';dN'SSIJ~ E;P~k~S ~..~~~ i t,-~ ~ .
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