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s.1o~. m.. d,. und.~,iq~,.d Not~„ PubN~, p~~.oo.M,,•,~P~d .~,7~,u~~~ ....~'«.,~;~:~(,~,C..~:....
who waa dul~r swom and shls tlMt h~ is (d» Ii«ar I~rinl f
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ILi~nor's Nsn~l
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and that in acoordana with ~ contr~ct with .....~e.l:C.1........~ J?.1~~t°.~.~G./y~ .
lieno? fumished labor seKvices or mat~rials consist~np oi: ID~scrib~ sp~cially hMicatsd matsriab rat
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on the foibwi ~ ~
ng described roal propsrty in ..............~.~..........~l.t.C.i.~.........................:........County. Florida:
(Des~xibe real propsrty sufficisntiy for identi~ication. inaludin~ strest sod number. if known)
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owned by.......--•-kQ.-)J......~.~~.~.~~-•.~.fl--~
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' qf a totai value of .L.~~~lI~~P~. ~~if~.- ..~f~•~ ..~.u.Gt.......dollsrs IS ..~i~.• f.~,t.••• ~-lJG1......•-•)
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of which tl~~ nmains unpsid i ...1 ~,Q.~ u~d fumish~d th~ iint of dN it~re~s on
. 18 and ths last of tM it~ms on , and 1if tM li~n
' is claimed by one not in privity with the ownerl that the lienor ssrved his notice to owner on
79_.......... by.....---.....---......_.....----••----.......
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(Msthod of Senrice)
and, (if ~equired) that th~ lisnor s~v~d copip of th~ notiw on th~ contractor on
and on ttN subcontractor.
by
(Method of Senrice)
on......••• .................••...................••••-.._......:......_....19.........., by....................•--•.......-•-........-•--.......-••.........•--•-...__ ,
(Method of Senrice)
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' Lienor
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Swom to and subscribed before me this_.....,3.~........._day of ......._~-L~ Q,L... 19.~
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~ Notary Pu lic ~~.ti= , ,
This Ins~rument prepared by: 6 519 ~ .
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Address ~
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~.r~~ ~ ~K1T4RY PU6LIC STA ;~C' ~.;~:r':~~= ~
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