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RAMCO FORM 120~'.
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and that in pursuance ot a contract with --~' ~~V ~'n `~c \~~r~ «~' ~ L~~~ }
~tts of ~lari~u ,
~~ of s~-~~~ ~ ~~~
Beto~e me, the undersigned authority, personally appeared ~~`t~ ~ t.. ~,
who, being duly sworn, says that he is the lienor herein or the agent of the lienor herein,
~~ ti.llU~..~: \ti_~t~~. S ~;}-` ~~-\ ~Z ~~ , ~+ ~ ~ ~ r ~C ,
(Lienor's Name)
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whose address is ~~ ~ c~ -~ L R .' ." ~"..~~ ~, '~ ~ ` : ~ ' ., `
(Lieno~'s Address)
! . .
~_ lienor (urnished labor, services or materials consisting of: (Describe specially tab~icated materials separately)
- ~.~~: v ~ . ~f ~ . ~ ~ ~ ~+ ~ r _ -` j i - + ( ~,• !~ L 1 : 1 t . , . , ~ . _ i ~. •1 ~ ~ . t ~ '.
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on the foltowing des~ribed real property in . ~ ~ ` ~ . `- ~~'~ ~ • ` County. Florida:
~ (Describe real property sufficiently tor identification, including street and number, if known)
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owned by --~- ~~~V ~ t \ ~ ~~\a\~~ ~~ ~ l. `, ~
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of a total value of "i ~ ~~.' ~.~ i ..!-~. ~ ~ t•!.~.a `.t ' ~ ~ dollars IS `j ~~. ~'~^~'• ~~~' 1
of which there remains unpaid S~~~t •~,.~ L~ , for which amount he claims a lien on the above
described real property.
He turther says that lienor furnished the first of said labor, services or matenals on \~i l'y~ .
. 19 c~~•', and the last of the same on ~,~ ~- - . 19 ~~ _. and (if the lien
I is claimed by one not in privity with the owner} that the lienor served his notice to owner on ~~ ~'~-
1
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~ .is ~5'.b~ :.~1~ t~~~-1,~~~ a~- ~`.,~~t~;~~ 1 .
! IMethod of Service)
and, (it the lien is claimed by one not in privity with the contractor) that the lienor served a copy ot his notice to
owner on
on
{Contracto-)
.19 .by
(Method of Se~v~c¢!
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
on ~' .~ , . . ylt, ;..: ~,,..19
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19$1 ~B ~y ~„ ~•_3~
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Sworn to and subscribed before me this ~°~
17~i• I r-.l ri~r-~~•n~ ~~r~y~nrr•rl l~~ :
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s~:M3 ~'r~~~
(Subcontractorl
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(Method oi $e~1'r~~••• •••••: !v%~.~ . .
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Lienor - ; ~ ; ;_~'-~ : . .~Y •
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/ Agent ~~Jrr, "•••.....~,'.•'
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dayof ~E'~ . ~~~~~~ ~19
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a~-, ,s~`~c v~. c~~
~~ ~ Notary Public :
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*~ (j 1AS/1~Y IIMIIC STATE UF F1rOlIQA Ai ~N~'~t /' I
1~~7 M~ co~wu~s~oM Exn~s ~wt. a ~+s~ ~`~``j~
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