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r~• 1!7) 1M{CNANIC~ HAMCO fORM 120'.
UtN lAW ff 71]W
(~l~tt~t ~~ ~t~rt
~te of ~loriDx 518~J$
~01~~! °f ST LUCI~
Before me, the undersigned autho~ity, personally appeared arllCC Yr~SkC Of YZ'~SYC ~':iV lat,
who, being duly sworn, says that he is the lienor herein o~ the agent ot the lienor herein,
Yr~slce P~viY= ~
(Lienor's Name1 ~ '
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whoseaddressis 31U?3 33rn 11~11StZ'iill AVC ~-- ~~~Cl,<<j ~ a-
(lie~or's Addressl ~
and that m pursuance of a contract with 1~Z'S •!ittt'1CC YLiS L, _
350~ S I~~i:~• kiver Drive ~
~ lienor turnished labor. services or materials consisting of: lDescribe specially fabricated matenals separatelyl.
' Cle~~ aY~ fillea cL•~ctcs wita court filler, ~~:~li^~ '~v-iia~ i
' ^~teri~ls, ~rulia~ Z ~IlC1C 'iexnis Ceurt ,.e:lei•, oz~ i•eli~y~
on the lollowing described real property in St LUC 1C County. Flonda: '
(Describe real property sutticiently for identification, including street and number, if known)
~441 S I~~i=.i Hiv~r Lr 24~0-311-0~2-JJJ/3
TCD NBH 283 44, JJ013 2b 35 4,; ~e~ lh"~ ~; Ft ~•f 2:'~ c;~r •f .\~
1/4 •f Stir 1/4 ta e t• nivez•, ts ~~..LY •s ~tiv
; 1J2 2 Ft 'Il +~ t• iNLI •f ~i~ 1/4 •f SJ~ 1/4, iy S I~ rvB-Less rttt
a.i~ ic~ k/W - (22) •r 352-11J0
owned by P~~Ci G!fc k~tT1Ce (i Li~tSt,
Tw~-tlt~tlSal~
2,J ~~ ~~1,
ot a total value ot
doUars (S
1
135~ U~ ;
' of which there remains unpaid S , for which amount he cla~ms a ben on the above
~
described real property.
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He further says that lienor turnished the first of said labor, services or matenals on F~ ~`~
I•
f ~ . 19 ~1, and the last of the same on ~C ~~ 3 . 19 ~1. and lit the lien
is claimed by one not in privity with the owneri that the lienor served h~s notice to owner on
i
~ r e ~ 2 `i' t31 '
.19 .by r~Ct •all
fMethod ot Serv~cel
and, (if the lien is claimed by one not in p~ivity with the contractor) that the lienor served a copy oi h~s not~ce to •
( .
owner on
IContractorl ~
on . 19 . by , ~
lMethod of Se~vice)
E and addit~onally. (if the lien is claimed by one not in pr~vity with the subcontractor} that the I~enoi se~ved a copy
Q, n
~J'v~ i ~ _ ~ v . . . 7• ' _
~ of h~s notice to owner on
? ', . iSubcontractorl
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,
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,
~ on "
i .19 .by
~ ' `~ • IMethod ot Service) " . . ~
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518~5 __. .
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f Fr~s~~ r~vi:_ .~..:~,~.,~.';::..:,
$.,., _ ^
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fruce Pi'~SYC Pr~ske ~zvi~~ ~
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L~enor _ ~~
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, Br ~uCe YZ~~SKC %+ ~
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,Agent - ~ ~• ,* . ._ T • .~ _ .
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Swom to and subscribed before me this ~d day ot
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l. ~` NIY CQMMKStON E7~1lB OCT . t1 19i1
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