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IIEN UYM. i~ 7170~ RAMCO fORM 1tO1S
~ ~l~tr~t ~t~n ~
~ SAINT I,UCIE ~
Bsfore me, the u~ds~sip~ed authority. pr~so~eally spp~ar~d ......ERVIN B. $US]~
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who, being duly sworn, says that h~ is tho li~~or h~rein or ths a~~nt of th~ li~nor har~in.
Bv.sx__POOZS.~... zxc.. .
. . . . . . .
(Uenw's Nam~)
whose address is ....................3309 OLEANDER AVE. FT. PI~RCE~ FZ, 33450
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(Li~na~ s Addr~ss)
and that in pursuancs ot a contract with .......rIR..... AND.. MRS. WII~LIAI4 MALI,UE
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lienor turnished labor, services or_materials consistin~ of: (Dsscribe specially fab~icated materials s~pa~etely?
TO CONSTRUCT POOZ AND PATIO
~AINT ZUCIE COUNTY
on the following described rssl propert~r in.........`." .........................................................................County. Fiorids:
(Describe real property sufticisntly for ident~fication, includin~ stre~t end numb~r, if knownl
1108 IR'JING ST. , PORT ST. LUCIE, FI,A.
owned by ...`~R. AND I+~RS. 'r`TIL7~IAI~I 1~1AI~I~UE
of e total value of . THRE~ THGDSA.~'VD FIVE HUNDB~ED AND00% ~~Rars 1= ..".~.3.~.F00.00
.......................i
of which there remains unpaid S...~ .t 5. ~ for which amount he claims a lien on the above
described real property.
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He further says that lienor furnished ths fiirst of said labor, ssrvicea or matsrials on
FEB. 7 t . 19.8~... and the last of the sams on.....J.~.hN.. . 20 , 79.~2..., and (ii the lien
is claimed by one not in privity with the owner) that the lienor senred his notice to owner on
19........., by...................._...... ,
tMsthod of Service)
and, (if the lien is claimed by one not in p~ivity with the contractor) that the lienor senred a copy of his notice to
owner on _ .
. .
_ (Contractor)
on . 19........... by.................................................. . .
' (Method ot Ssrvice)
and additianally, (if the lien is claimed bY one not in privitr with ths subcontractor) that tha lienor aerved a copy
ot his notice to owner on . . . . . . . . . . _ . . _ . . . . . _ . . . . . . _ . . . . . . . . . . _ _ . . . . . . .
p.~s~ (Subcomractor)
5~~7~If~?
on. . . . . 19..._....., by..........__... .
I9i8'1 JAN 28 P!I 4~ t 9 (Msthod of ervice)
rflEO ANC FfC~t0E0 -
ST.LUCIE COU?1~Y.FLA. .
R(~£R P01T6iA5 L' r
CLERK C1RCWi CCURT
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Sworn to and subscribed before me this _ . _ _ _ t ~ ~.n`' : _ _ 19a.?.....
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