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HomeMy WebLinkAbout1800t ~~ 515~235 ru ~s» wc.~.r+cs NAMCO FONM 120%i .K~ u-w rs ~ua~ ~Cl~tim ~f ~it~rt ~~~ ~~ ~ S~. Lucie SNo« m~, tM und~~si~n~d authwit~r. pe~sonally appes~ed ~. ~ Al . Ches s e r ; ; vrho. bs~~g dul~- swwn, ssys that h~ is the li~nor hersio or the agent of ths lisnor herein, . i Chesser Tractor Service,Inc. lLienor's Nams) ~ wlwse add~ess is t'~t • 7.a.OX 535 ~r. "i t/jC P~ ~~Q ' . . (lienor's Address) and that ~n pursuance of s contrsct with ~SCc~~ xQLtCl~; 147~1 Tyler ;:t. ~:i.amx. Fla.. 3~1~~ .. . lienor lwnished labor. services or materials consisting ol: (Describe specielly tabricated materials separately) I Tractor ~fork = (mow Lot~ .- on the foibwing desc~ibed real prope~ty in S~ •.~U~~e .. County, Florida: lDescribe real p~operty wNiciently for identification, i~cluding street and number, if known) , =~ tz Street and Avenue ~:, ~ owned bY OsCa~' You72~ . of a total value ot r 1 f ty-.`.' 1 X A11d OO~l OG dollars IS 56, 00 1 of which there remains unpaid S 56 • ~~ , for which amount he claims a lien on the above descri6ed real property. , He further sa~rs that lienor fu~nished the first of said labor, services or materials on Apri 1 '2 ~Z ' . 19 ?~ , and the last of the same on ~ecember , 19 ~~ , and (ii the lien is claimed by one not in privity with the owner) that the lienor served his notice to owner on ~ anuary i L 1 :.^. . 19~~ , by ;~~311 ~. , ~ (Method ot Service) _ and. tit the lien is claimed bY one not in privity with the contractor) that the lienor served a copy ot his notice to i I [ ~ ~~ne~ ~n E ~ ~ t. r_ ,'9 lConbtractor) ~ • Y . . ~ (Method of Service) = ! and a~Jctiuonally, (if the lien is claimeo by one not in p~ivity with the subcontractor) that the lienor served a copy : i ' of h~s notice to owner on ~~C~?~C (Subcontractor- ~~ irt~) on . 19 , bY ~~ t~~F 2~ ~~ (Method ot Service) •r ~~. ~ [~ F'-:c ~^~~ _ ;. ~ Chesser TraC~ox' ~~xv~c~ ~nc.. ~t i ~~.~~ ~: '.,: :F= - . . _ t C. f C 1r' rr. .~ . ~ .. ;'~r: -' ~' , + . Lienor _ . . 7I"~ = / B ,.Y.. Chesser. . .~, .~s-:~;r~:,,:' "~~ . i Y Agent . - '`'!!~~'• +'~ , Sworn to and subscribed before me this v~~~ _ day of 7~~/~t ,.: •`~ ~ r t -~~ -.. . '.~~ 19;~;.~.': ' ~ .- ~. - _~`t.. ~)"1~:~-~.~ ~ : ., : Notary Public ; ' •r ~; °• ~~" _ ~ I I I ' I-' Chesser ;,~~' ~-,~." ~~ :• ' ~~Ns q~//IfN1~•fll /II' lIl/fY ~lt: J• .• / N~tary Public, State of i~orj• ~ t '~~~~, ' f ~l~l ~•••, _ ,~( t . ? b0 X O !„ comnicsio~ ex ras Feb~ ~f~ ~ `''.: 53 Y ~ ~y4, »a~ p~r~ ~4? ~,~ 1?94 s~d@d wi15 Lawyers Surety Corp. ~. g ~ ~ t • S s: x " 6 ' . ~~ ° - _ ..: . ,.. '~'. . .s ~ f I ~ J I # ~ ~