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HomeMy WebLinkAbout1241FI,A. IY67 LAWS ' ~ 11AMC0 /OIIM 1lOM y 51~8"r4 / /S 71,.09 t ~l~tim ~af ~t~e~t ~~~ ~ ~~ B~for~ ms, fh~ und~ni9nsd aWhorif~r. Wrsonally appea~ed~--~..../..!l.......~.'~"..°...0~^~" . Ihe ayent who, b~in~ du{y sworo, says that he is- the lierwr herein or ;~~~y # of ths lienor hsrein, . ............. .. ... C~GLG .... .. . ~. ........._ ....... . . ..............._.......................~............... .. _ . . .... ...... .......... . . .. ...... . .. . ... .... .. .._ . . .. .. (lienor s Name) W~~ add~~ ~s......... ~..~.~.....~. o?~_ ~0.~ .. l~,c r~~e~~..{~a~., ....~...~. . 3.~~"1~` . . . .., (lienor s Address) ...._... .......... .. ... . ..... . ... .. ... . . , and that in pursuanas oF a contrad with ~~~. ~`'~'` `.^.~r..!~. .. . .. . . . ............ ........ . ...... ...... ................. . . ._ . . .. ._. .. . lierwr furnishsd labor, services or malerisls oo~sistin9 of: (Describa specially Fabriwtsd materials s~parately) . C~r.c,~~e~~, ,~ ~ of a totat valus of..__.-.... ..~.. ~.dollars (s of which thera remains unpaid S ~/~~~ ~~ , for which amount he daims a lien on the following ~ ~. ~~~~. desrnbed real P~~~Y ~~ . . .... (Desuibs real property wffiaeMly for identification, indudiny streat a~d number if known) ~~~- ~~~~ ~-~" I~ f z , ° ~3 ` -_ 1 ~ 1~ ~ ~~~~p ~o /`~ ~ ~ c~ 0'?,~~~=vvt~~ ~ ~ GC~~, '~f.ll~ii ~ . ~ ~ ~ ~ at~~ o,~d b_r 1.~~~- ~'~~~- ~ ~ c`~i r~ 9'~%,~ ~~ . f~- Br~ru,~ ~( r . ........... ...... . . .. . . .......... ... . ~ ~ -~.~,t~-. ,~S-~w ~ He further says that (ienor fumisf~ed ths first oF said (abor, services or materials on .. c.G'I-~2. .............._......---._-.............---....._, 193..~; and the last oF the same on........h~`~."~.-. ~. _.... ., 19 .- , and (if the lien is dai~sd by not in privity with the ow~er) tha~ the lie served his notice to owner on J .` ~ ~ ........... ~t ~ . .. . . ... .............., t9.. ~!by.........~. ~ .. _ ~.J. ~ (Method Service) . 19$I J~~1 26 P!~ 12- Z~ ~.:... ~.~~.... ... . .. -~t~C t-,_ =_r,=~:.:: lienor s148'74 ~'~`~~~~`~~~~,~:F~~ ///~~~ `~1 ~~(,t~ By. . .... ...... .. ..~ ..... .......... ~w . -1~'. rf~ ` ~ ..... .. .... . CLcnK Ci: . - ~ ~ -- .r _ _ ~, ~ M or Affomsy •- l. ~ r ~ : ~ ~ ~ ~- ~ n• ~` i ~ ~.. Sworn to and wbsa~sd bsfae m~ t~a .................c~~_..:.~.~.'•~S~~''......... .... ._. ....... Q_. ~ . T - ~ ~ ``~=^~~• •s~~~:14I~''i_ ~ v 7%u Lu~rruru•~~~ pn fu~r«/ ~y: fI (~[~/l'SS ~ 4 ~~! '••.....•• STAj= c~ ~~~e~ei~+~~`~'~~ ..~No~ary Pub~c .~9 ~~ ~, _ . ~c- CwaR. STA7F Of FtCR7DA AT CA~;E ~•~1QM1;M15.,:.,: c.1r tic~ u:_ t; 1= - L~ ih(~ v_..c..n~ I.~S . ~..._.n~YKi::61 Counfy, Florida: > ~~ 3 i ' S t ~ ~ ~~~.~.~.:._:~ t . - -- = -- ~ ~R~K347 ~A~E1238