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THIS INS1R!~!!E-N'f PREPARED BY:
FORM 1S7 Ctaim q/' Liex S~*~~r JOHN H.
PARKBR, III
Post Office Box 980
cxecutive line Live Oak, Florida 32Q60
(904) 362-66S0
~~en
St1~te of FLORIUA
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BEFORE ME, the undersigned authoritd, personally appeared CURT BROOME
who, -
being duly sworn, says that he is (the lienor herein) (the [agent] [attorney] of the lienor hereiri)
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whose address is ...1531 S.E.,_Airosv..Blvd, Port St. Lucie, Florida 33452 `
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and that in pursuance of a contract with J~ B PAINTING, 2700 Forrest Nill Blvd, ~
West Palm Beach, Florida
lienar furnished labor, onsisting of ...P.ainting . . :
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(Describe specially fabricated materials separately)
on the following described ~eal property in St . Luc ie
County, Florida See Schedule A. .
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(Deseribe property sufficientTy for identification and give street address if available) -
' owned by ~nds Ocean View Development Company, a Florida corporation
of a total value of 904. SD , af whieh there semains unpaid s...,..904. 50 .
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and furnished the first of the same on ~y .15.........................., 19.. 83... and the last of the
~•same, on August 20 ~ lg 83 aRd (if the lieR is elaimed by ane not in psivity
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~~Gw~tlrfh~'`o~rt~i'~;,that the lienor served his notr~e to ow»e~ on N~A 19......... by
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~~~~brs- b~fhethod of service of notice)
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..rr.:~.~s~~'` caxr aROOr~
_ Lieno~
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22nd
= Sworn to and subscrihed before me this ..................day of..,.. October , 19 83
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S~1UK ~1~ P~CE ~ .
Nota Public FI id G V (Nutary Puhlic)
?Y . a a. State at Large
M;?Comm~ss~~~nExp~resqp•i125, ~9g~ Copies by certified mail to:
My Commission expires Southeast General Contractors, Inc.
Harbor Federal Savings and Loan Associatlo
M~DSTATE LEGAL 3UPPLV GOMPANV
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