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5~5195
~i• »n M~c~ur~cs RAMCO fORM ~20'~
- -K~ .~M .s .~aa (~I~itl1't ~~ ~t~Y[ ,
~~~
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8efo~e ms. t~e undersiyned authwitr. p~nonall~ sppesr~d ^~ ~1~~ :-
who, bei~g duly swom. ssrs that he is ths lisnor herein p the s~ent ot tlso lienor hK~in.
~iE ~iPSo~vw f ~o v ~~i L~~~~~~~~" ~~~i~ /1l"~i~/~r~oilrCd~ ~'
(L~eno~'s Nsme)
whose address is ~~~ "'' ~ ~ ~ ~/ ~ ~ ~~~ ~~~ ~/ • ~v~ ~~ ~ ~'l ~~ ~Z
(lie~+or's Address)
and that in pursuance of a contract with .p/~IQ/p~ ~f~E ~~~ .
lienor iurnished labor. services or materials consisting of: (Describe speciallY tab~icated materials separately) _
~f -~"~~ ~ •//?~7~~-~i '' -~ '-
C]~ ~~~Y~L~ ~~"'w ~~
on the tolbwing described real propsrty in ~k~'- ~~^~~~/ County. Florida:
(~esctibe ~eal property suHicientl~r for identification. includin~ street and number. it Mnown)
~~0 9 ~- ~ ~~~~ r~ -
p~ ,~z'`. d~~t- ~ 3 3 ~ ~
owned by ~ ~~ ~..~~ '
~
of a total vatue of j~~ ~~
of which thare remains unpaid S ~~~~ !-v
doltars (S ~~G " ~~
, iw which amou~t he claims a iien on the above
desc~ibed real ptoperty.
He further says that lienor furnished the first of said labor, services o~ material~ on ~
'-~ Q/j~2,~ _ . 19 / 7. and the last oi the same o~ (~- . 19 6 Dand (if the lien
~ - ~
is claimed br one not in privity with the owner) that the lienw served his not~ce to owner on
J ,,9~D.er .
(Method o( Ssrvicel
ar~A. (if the tien is claimed by ons not'in p~ivity witfi tfie cont~actw) tfiat the I~enor served a copy of h~s notice to
owner on •
(Contrsctor!
on . 19 . bY
(Method of Service)
and additionaity. (if the lien is claimad by one not in privit~r with the wbcontractor) tbat the lienor served a copy
_-
of his notice to owner o~
~~
on ~ .~;:i Zg ~~~ •~' ~'~ .19
Si Li~It~iCU:i' i t: t~
RCt'iER PG{iRr ~- n .
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515195
~~~
Swor~ to and subsc~ibed before me this '-
1 /~i• liidri~rr~• nl ~-r~•~i,n.•~/ l~~ -
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(Subcontracto~)
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.bY _ - _. •~.
(Method of Serv~ce) , r : ~i ~Y
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Agent ~ ~ Z =~ a . ~.
day ot1 ~-`~ Lt •,l~ ~~~ ' T f - •' ,.
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otsry Public
NpTAR- ~1AlIC StATE Qi flOR10A At t/~if
1~ tGw~MtSS~oN EIDIRK JUl1- • 19e2
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