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HomeMy WebLinkAbout2080 ~~4 :f71 M~~NAA~Ii RAMCOfORM t?O~: li~p MW i3 /1JJ~ (~l~tt~t ~f ~.~t~rt ~txte of ~lotiDa . ~ ~ouict~j of S t ~~< < < i~ . Betore me. the u~idersigned authority, personally appeared ~ ~~~~~ ~' ~~ ~ ~ ^ •L ~ ~ who. being duly swo~n, says that he is the I~enor herein or the agent ol the lieno- herein. ~ - , ~ '/ "/, ~i ::~ L ,. ` ~l /L t ~/C C`. ~ /t, : /l ~rIL . c~ ~ ,t ; ~/1 i ~~ ! ~i ~~ ~ . ~ • , S r,,.' (Lie~or's Name) ~ ~ ~vhose address is ' ` l `, ` , ( C /; ~ ' `~-~ ~~t l,j,. ~ ~ ,~ -r- ; ,irl , !ul !t ~lis` ~ ~ (L~enor's Address) ~ , and that :n pu~suance ot a contract with ~ ~! ~~ ~ ~ < < ` `~~ ~~~~ '~ ' ~~` ''~ ~~ l7~illcf . `/_i ~// y~,~'% %~/~C .~,~/l/~ '!/`~ . lienor lurnished labor, serv~ces or matenals consist~ng of: (Describe specially fabricated mater~ais separately) `• ~ .c- , ~1 i`1C ,•' .l~/l.t l~c~~~~G %C - , ~, . : r ~~•' / ~ ~-, i= ~~ ,--, . ,t ~ ~ . :.~ /~ ~. J ~ 1 [ C ~ [~ i~/~ ~( , ~ ~ ' , t /'~ C ~ '~C __ . l"/. // ! % ' t .f .l i ' . -. / C L , r < /'~ / /1 _'/ L% ~ J ~ ~ ' ~- - ~ . ~ ~ ~ - ~l ~' ~ ' ~ . o~ the (ollowing descr+bed real prope~ty in ~~~/ ~~ <<~ !~ L County. Florida: (Describe real property sufficiently tor identification, incl~ding st~eet and number, it known) , / = : ' ~ .! .~ _ c ,~'( ~ `. -~ ' c~ ~" ~ ~ •t ~/ ` . ",'. '~~-'. i( i- ~ c i ~ / L ~_ ~t ~ ~1 T- - _ - h / ~_. ~ i- ~- i _ :~~ , . •'^ i'% %% . . .~ , -~ ., ~' ~~ , ! . ~ t .r.a. %./ ~ C. /,~ • owned by .: l' ~YI L_ ~ ~ ~ t `1/; /S ~ / ~ C ~ /J,!/~ ~ , / /i /f !t r~. ~) /`!` ot a total value of ~` ~' !` ' . ' '_ : ~~ -'/-'~ ! dollars 1S '- ~- ' ~ ~~ ~ ; 1 of which there remains unpaid S ~'' << ~ ~ ~^ , for which amount he cla~ms a lien on the above drscribed real property He further says that lienor tumished the first of said labor, serv~ces or materials on 19 , and the last o(_the same on . 19 and t~f the lien ~s c~airned by one not in pnvrty wrth the owner) that the lienur se~ved h~s notice to owner on 19 , by (Metnod of Serv~ce) and. l~t the hen is claimed by one not +n pr~v~ty w~th the contractor} that the t~ersur served a copy of h~s not~ce to owner on tContractor) on . 19 . bY iMethod ot Service) :+nd addit~ouoiiy. 1~t the he~ is cla~med by one not ~n pnv~ty wrth :he subconeractorl that the Iienor served a copy ~ / 5''' iJ9 nf h~s nudce to owner on on ~9Jt t'.~? 3'' Pi{ ~' .• t. ,~~~SI:UINIIi~. . 19 , by :+' ~•; ~~i."' 4~f':, ~~~.....,,.. iMethod oi S@T~v~A1' ~~ ~ ~ . •~.-••,.. ,-:•. o % . '' _~ _`,''~ ~ ~ ` % L /3t.j~'f" j91~.' ~ f.i; s`'. .F~ , L~enor = ? S ~;• ',;.-~. : G .. _~ Gf • ,~; . ~ ~- By :i J . ;-. . _ . `a. : ~ 4 i~ t~'. •. . ' ~~! Agent ~. ~~ '••......•• -~, ~~ ~:~~, . ~'~~. day of ~ ~ «_l L ~,' 19" . - --, _ --==-~ ~-- ~rn ~m c - c~«.~-~- ~ l/ ~ Notary Pubhc J no:~r ruu~c stRr~ oF aotwn W Mr tro~uss~a+ ~v+~s ~t. ~ I~si- WNDfD TIlU CBdK Md . 1~~ lSubcontractor) ~IV/V~~~ ~T;tt'c ,, . _ . . ~:i;rJ:~- 1 :. . '_i.,. f. ~ ' 7 . , . .. ( .i/1 ~ -j V , '' Sworn to and subs~ribed betore me th~s ~`~~ `~ 1; ~ ~ ~ • ~lri~ ~~r~li~~m~ r~f ~~-~~~~r-i~•rl 1~~: 1,/,/-,~,. j,l~ ~,A~~~ ~M~~~~