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a~ ~sn MEtw-N~CS' RAMCO fORM 120'i
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Be(ore me, the undersignsd authority, personally appeared ••~' ~~ C 1 ~ C~ ~ i~: : ~;~, ~ i t L, '
who, being duly swo~n, says that hs is the lieno- herein or ths agent of the lienor herein,
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(Lisnor's Name)
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whoseaddressis. 4.~i:...~~~? ~ 1 t=.. --t.C.<.','.:: ...:~,'.S ~...~.~..~~.. ,•~.~G;•, i . - _ ~:~~:
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(Lienor's Add~ess)
and that in pursuance of a contract with . . +, : ~ ~'.1.1' G -; :. :.. [; ; r 1 '.;: r.: , ,: ~ ? f : : , '
1J'v~!.. •.4t.~-1'~'.~.... ~,'11,•.~7~ .. :-.~.<<4....~.\.,r~1~ 1 _1.. .[./~,JL_ ,
lienor furnished labor. seivices or materials cons~sting of: (Desc~ibe specially fabricated materials separately~
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on the fotlowin described real ro ert in. .. ~ ~ ~~~_
9 P P Y County, Florida:
(Describe real property sufficiently for identification, i~cluding street and number, if knownl
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oW~eabYRadn~r.~:....:~a:-.~_=,c.' -:,. ~'-.-.-~~: rs.~..j~'.~_.--~ ~:~~ ~-~ ~ ~,~ ~_=~_c,~. .,_ _.~ . ~_~.
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ofatotalvalueof . ~: ;•...~•..=::~ci~~ ;c~:~~ ~:~:r:~r~;~. ~~~.< ~;~ ,:.deltirslS :~'..~.c_ •
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of which there remains u~paid S . ' ! .`: " `- • ~.' . .
for which amount he claims a lien on the sbove
described real property.
He further says that lienor furnished ths first of said labo~, services or materials on
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- - . .. ~ T . ~ `' . . . 19. . ., ,., and the last of the same on .' ~ C ~ . : ~ ~ ~ ; . 19 ° - . and lil the lien
is claimed by one not in privity with the owner) that the lienor served his notice to owner on
~.~.,,V..:.: ~ t' ~~.s..... .19.~...~.,by .;;.1'~1 ~ 1c:4..,_:•.1.i. ; i.~-...l.i, ,
(Method oi Servicel
and, (if the lien is claimed by one not in privity with ths contractor) that the lienor served a copy of his notice to
owneron. _.,.;;%1 t'~1:,..~.!-..~n.). ...~.r:.- ~];.'
(Contractor)
o~l':~' `~.:.,..~ :.Y._~... . _ _. . 19. ...._ , by.... ~ ...t :_; , i.~.. .. : i.1 . .. ~ .. _ ~.: i~ .
(Method oi Servicel
and additionally, lit the lien is claimsd by ona not in privitY with the wbcontractor) that the lienor servsd a copy
oi his notice to owner on . _. _ ~
• ISubcontractor)
on . 19. . _ . bY.. _
(Method oi Service)
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Swom to and subscribed bsio~e ms this __ i.,L_~:._...__ ..... da~l Of " ~ ~ -= -
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Notary Public ` ~ ~'•
7hi~ Ins~rumrnl prrpar~~d h~•. - ~ * : r t ~:~ 1 1 ! : r'. ~u ~ ~.~~ .
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(IR ~ . _ - - ~ I~~•"~ ~~~. U1RGE
E~ix 349 P~~IE ~o ~ `' S ` .' ~' ~ ~ ~ " ? C . , ~ i . ,. ~ ~ _ r: MY COM.v 1551 ~N ~ui'[~ .~Y ~0 19 fi!
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