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HomeMy WebLinkAbout20575~21i~'~ L.a ~ ,,. ~,, .+,, .,:., :-~ r;~.n,c c, r;,-~.~n ,: o ~~,~w ~~w ~, •~,o. ~ (~l~in~ ~a~ ~rtp~t ~~Aft Of ~IOT _ . ~ ' ~ou~ of F- •1~ -~ « < .~~ ~ ; ~-. . ~: ,: ~ , . Betore me. the unde-signed authority. personally appeared i:. . '~,/; ~ ~ ~ 4 ,_ ~? ~• " = ~ ~ ~~,~ ~ ~~f''C L4 ~(. -~< <~~' ~~'i' (; i -who. be~ng duly sworr~, says that he ~s the henor ne.e~n or the ageM ot the lie~or here~n. ~ J %,.1 .~ ? ., !\ ~t, _ 4. _ c ly c /i 'ti L ~' ~t : i~ ~•' • ,' • ~L _ ~' ~ . . ~ ` ~ ,. ~ ~ il~enor's Name) i - _ ! , _ _. ! whose address ~s ~ . ~ ' _ t r i< <' ._,~/ i',. /L /'~ , i 4 •~5 , " L U~ ~,`! . ~ ~ f ~ . ( (Lienor's Address) ! and that ~n pursuance of a contract with l/ r'^ ~~ ~ t,: ; L ~f !~ ~~~' ~ t" : i! i" , ~ C;~ ,_,- . ~ l. ..'<~`, ~ ~ ! u' '! j ! l~ . I~enor iurn~shed tabor. services or mater~afs cons~sting of: tOesc~ibe soecially fabr~cated materials separately) ~ ~ ~ ~~/ . /. ,'{~ , /l~~_i~,ii~,:~ ,J~, ~~ ~- << ._ J: ~:~ _ y-- ,~. .~i/`:~ ~ -t _f• ~ /r/;t/ ~ ' . i . ~. ~ . , ,•_l ~ ~ J ' j - c _ i e f- ~-' _ /~ 7 < . . i i , j .. i L c . _ _ . ~; "~~ ' _ ' ~- iC - . ~ I ~ ~ f ^~ ." / -i. ' .'/_ ~ f • 7•~ ~ i on the followmg described real property ~n .~' '•r ~ -~ ~~~; -'t. County. Flonda ; IDescribe real property su:t~c~ently for identif~cat~on. ~nclud~ng street and number. it known) ~ j ~, ` i . . ,~ _ , ' , ~ . r - ~''" . _ / ' - - . . . /~ i /i. i . . ' ' ~ ' _ _ '.~ J ~ .~ . / , . / . i . ~ ~ . ~ _ . ( /~_ ~ l ' r ~~ ~ ` ` '- owned by ! ~ , [ ' /f /I ~ ~ ~" ! ~~ /',~ ~j 'i ~~ , ~ ~ ~ .! ' %. _ !~ -: i _ . .• of a total vatue of y"- ``~`" /~ .`~- ~ . . - - `; ":'~ l dcllars (S `• ` ` - - - 1 5;- . ot which there remains unpaid S ``~~ . for which amount he cia~ms a I~en on the above ' descnbed real pr~perty. ~ He further says that lienor tu~~ished the first of sa~d labor. services or mater~als on ~( ' L ~~ ~' '~~~_ . i ~ ~ . 19 .' ~ , and the last of the same on /'~ ~~ ~~ ~ _ ~ _ _ ~ _ . 19 .c: .: , end (it the Gen I ~ ~s cla~med by one not in privrty with the owner) that the Genor served h~s notice to owner on ' .19 .by . ~ (Method of Service) ~ and, (if the lien ~s claimed by one not in privity with ths contractorl thai the I~e~or served a copy of h~s notice to c :. •:er on IGontractor) c, ~, . 19 . by , (Method of Serv~ce) a~,~ a,i t:~nally, lif the lien is claimed by one not in Dnvity with the subcontracior; that the I~enor served a copy 01 hrs notice to owner on - ~~~~~~~ c~ ~ j~~~ ~r~~ ~~ p~ j: ~~, •'I E ~ !pi h: tj.: :•t. " "~ ' r;i`~ri:f li!; ~ .•~.13: ' ~~ t' •.~:. _ `"t. ' . ' ~ ~ ~ lSubcontractor) 79 ,by (Method ot Service- a/ ~ ~ _ ,'~ l , ~ ..~ : ~ _l `- -,---. . Lienor '< „~: •*r ` ` .: .., BY . .~.• ~`!'~•i••• ., , ~~ Agent ` • _; 2- v j•, ~ day of ~ ~ C~ C = ~.,~ ' „' ~L9. ~/ ~ ~~i'• . ta~.. . ~ - .~` s.- ~7~'~ ~- -:•- 'V.. . ~ - q .' ~ _ _ " r' NOtery PUb~IC ~~~.~ ~~~~~~~~~,.•1 . •~~','~ N,, _ tr~, f . f ~~Li. ~Rr IuKK AATE Oi AqM N NI~ Q•~ M CUMM~SSI(~!1 ~~ ~. ~i ~~ ~ •~ ~~ t~ ~..~.~...~~ ; ~~ ( ` Sworn to and subscribed bei~re me m~s ~ l7~r. I-~.liurr~~~itf prr•~~ur~•d I-~: I,i~l r~•.. ;~K ~~~351 F~~?a53 . i -, ~'i . ~;^,,,- .4' .~r . ~".' = ~ i! ~' ;•~