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564244 ~
t~~~t~m ~f ~.~i~en ~
State of Florida ~
Counry of p Di"'~-S L.~C~ Q.
Before me, the undflrsigned authority, personalty appeared _ / ~ I` ~ 1~~7' E~.
Me agent ~
who, being duty sworn, says that he is tfie lienor herein or ~~~x ~ of the lierior herein, _
S C~ -~~.~_~,n C -
Ilienor's Namel
whose address is ~ ~ 1 ~ ~G ~ S ~ C~G d ~ l~ ~ ~ e- ~C e--. ~
ILie~or's Addressl
arid that in pursuance of a contraCt with ~~0. ~ ~ v S~ ,
and for the improvement of the teaf property, hereinahet desc~ibed, lienor furnished Building Mate~ 3Is ,
ofatotalvab~eof~~Vf. ~~C~. ~~(1e.~ndit~~ ~t'~ ~VC5~16.~2.,t~dollarslS 1
of which there remains unpaid 5_~ for which amount he ciaims a lien on tAe foUowing
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described real property in ~ l.? 1 e~ County, Fb?ida:
(Describe real property sufficiently for idenbhcatron, indudmg leyal descnpiron, street and number if known.l
i ~ ~ D~- s s~- 5 c~.~- i~ 1~, ~ L~c,k.13'1
5~.~ a P? P e~~- ~q~ s~ t~-NAR 23 PM ~ I 3 ~
iQ ~z 1 244 r
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ROGER F01 ~ R~. S
~ ~1 _ - 1 CLEFK CIRCyN C~3tiRi
Owned by - 0.-- Le'~ 1J~ 5~
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nrl a.~~,la_ ~
He further says that fienor furn~shed the first of sa~d materwls on €
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~ , 19~~~and the lasi o} the same ~n _ 1 Gl t`C T\ 19~and Iif the lien ?
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is claimed by one not in privity with the owner) that ihe lienpr served his not~ce to owner on _
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~ 19---• b~ ~
IMethocl of Service)
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~ A copy of this Claim of Lien has been furnist~ed to 1 i
~ , the abovo-~amed ov?~er (and all other entitted to ie~p~ ~
~ receive the samei by certitied ma:l Eretum receipt j
~ requeatedl. ~
Q~~~ Prepared By
" Certificate Number t=~'S v
~ Agent
~ m~~ day o+~
~if'
C~. ~ s~ ___~1 E~ Lu ~9R11 S 2oAl~ _
A , . ~T. ~t~ , t'G ..~.~~so
~ Ad ress
~q to ~nd subscalbed befote me this r~ day of m a r~ h 1951~'~
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1 - • = ~ ; ~ Notary Pub~ic ,
~ `I ~'r / f.~ P10TAAY DUbUC STAif Of FLOfitDA AT URGF
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P ~'.C~~ - My Commiss~on Expires: MY CO~ a ~ ;
~ ao~K 373 PdGE 948 g~~ TN~~ ,N~ . u?~w~~~T: s :
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