HomeMy WebLinkAbout195451'7U12 L~ -
~~w w,~ ~r~~ ~ur~~ ti NAM~-U 1 ~-I~M 1I11 .
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~ru~~~ ot ~(t~~~a,~
~oiad~ of ,~ o~ ~
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Betore me. the u~dersignad authont~. personally appeared
who. be~ng duly sworn, says that he is the I~s~or here~n or the agent oi the I~enor hera~n.
~'~ ~'~~~~ , ~
(L~enor's Name1
whuse add~ess ~s ~~ ~ ~V (/`" `• ~~ ~ ~~^' ~-~--~C. - -
lLienor's Address)
~L2:~~r~ ;
and that in pursuance ol a conlract w~th , ~
~ • ~
„ 1 1 rn sh la or services or matenals consisun ol. Descnbe soec~all tabr~cated mete~~als se a~atrl 1 =
I~e o~ ed . 9 Y N Y
C~~ ~ .
. ~ .
. ~~ , ~~
J~ i~~ .G~CC i%r~~l%~G~ ..~2C,1`~ " ~ ,, ~h .
~~~ L~ ? ~ /~ '2~ ..~~C ~ ` S~~ _ .
~ L' /~O ~ ~ u ~ ,
S7` ~f'~ / ~~r,~~ ~ :
o~~ the follow~ny desCnbed reel propsrty ~n County ~ Flor~da
(Descnbe real property suthc~enlly for ~dentiticauon. ~nclud~ny sUeet a d ~iu nbe~, d knu n)
a`~6 ~~,(' 990 ~~°°y ~e . ~,~ ~ ~,~~' fi/~ ,
~ I `~~ ~~~ GL~ , . ~o~ ~ ~c~ /~1
~ ~ /
y
ot wh~ch there remains unpaid S V/ /~•~
ol a tutal value of /~ ~'
~
ownad by C~~'~!"""
~
descnbed real property.
dullars (S
, for which amount he c~aims a I~an on the above
He.lurther says that I~enor lurn~shed the lust ol sa~d labor, serv~ces ur mater~als on
~~ /~` d%~'~1 . 19~7C/ . and the lest of the sume un ~/>,~~`'~ . 19Q ~. a~~d (d ~hu hun
~s cla~med by one not in pnv~ty with the owner) that the I~enor served bs nohce tu bwne~ on
~ ~~ . 19 a~. by ~~" (r- C~t~Ga~l.~ ~~ .
(Method ot Servi e1~~~
and. (~1 the I~en ~s cla~med by one not ~n pnv~ty w~th the contractor) that the lienor served a copy ut h~s not~ce ~u
owner on
, - .
(Cont~ectur)
on~ . 19 . by .
,~, 1Melhud ul Se~v~ce)
end add~bu~ially, (~f the hen ~s cla~med by one nut m pnvrty w~1h the subconUacto~) Iha1 Ihe heno~ servnd a wpy
ol h~s not~ce to owner on
(Subcui~tractor)
on ~~~~]1 ~j . 19 . b~ ~
vir~+
(Method ul Serv~ce) -
. t9al f E~ 13 P~1 3 53 ,~ ~'~~~,,~ ~_ d.
i
~ FILEO Ch[ ~='' Y.f`la. L~enor
5?.l tltif CC~~:
~ FiC,GER P01, ~ :~~ , ,,;::~,:,., ~jv~'ich~.~~ G ~ C ~ ~ ~ ~
,,,._• ,
~ ~~«x ~;=~~~< <<~~, ,, .
,~ -.e~~,
_ . ~c~.~'I''`s~.C~t ..~ ~ :: • . ~ .
. ~ _' ': ; ~ ; • -: Ayent
. v: : • ~~~~_ ,
Swu~n to and subscnbed belore ~ns th~s ~~~ ~^ ~r~ ~{ 6, 19 ~
~ _'~"+~ ~ " ~ Q . `
,7• ~, ~ 2-~~.. /
.~ ~~.~ :
••...:..'~ tVf'::
ll~~. ln.lrame•nl pi~•pn~~•~l I-~: ~ ~~, ~t'~`~• `
i ~ I~I~II~•.. :t~tt~-i~+`''~~ ~T~Y ~g~ SiATE OF fLORtDA AT U12C,'~ -
il~~ Q ~ • ~' .: Y CC.'r.ti!ISS~~.r~ Ex'r~KC~ u:
' F~~!K•J~~J PaGE~~~•J "..,..._J ir,R ..,~ 17 IY~1
U v.~..a..l l~.~ .
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e:
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te ':y:~~u~v'~r'; _ . ~~ -. . .. ...> .-.y .. ... ~-'i _,:._~x. .