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~ • cTO ee RECOf2DED)
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Lots 3 a,nd Bailey~ B S~bdiv3s~on j as recorded i~i
~ P~operty to be improved: . . } _
- ~~lat~Book~~+~ ~at ~~Be ~~5 ~of ~t~.}ie ~~ub~c ~Recoxds'o~`~
; ~ St. Lucie County~ Florida. `
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~ Genera? description of the i±riprovement :
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~ Name and addsess of Own~r: ,~x'~:.s~. Jennings - .............1964_Q~C.~Z...P~..~.~lj~..............
...~0901 S°'~t,~ r°~. ~ve ROGER PUII~iZAS. [~Ltit~(
' ........................................................~?'t.1[~sexce~..F1,~ricla............sT:'l'UC1E'"CQUt~1`Y;'FL~i~~DA..
Extent of Owner's interest in property: (fee .rimple) other : .
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Name and addre,ss of fee nmple title holder sf other than Owner.
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f owne~ship is othe~ than. f ee simple, the name and addreas •o f the • f ee simple .title •holci~•mu.r~t ~ y
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ulso be giaen) • ' ~ ~ -
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. Name and address of Contractor : :
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~ 1Vame and address of surety on payment bond, if any, aad-amount of the bond :
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Nome and address, within the State of Florida, o f a person other than the Owner rigning this
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notice, designated by the-~~tnde~signed to receeve service of noiices or other documents:
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liTame' and address of person to receive copy of Lienor's Notice as prouided in Sec. 84.061(2)(6~ '
_ ~ ' _ Florida Statutes (Optiorcal) : . ,
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~ Dated this......28th..day o f. Noven!ber 19.
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' ~ Signatu e o~t?umer (of honzed age~t)
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m, Subscribed and sworn to be
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ore me tFeis . ay o.. ,
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~ My Commission exps'ser..~ ,r- -
o~ a ' gent of Oumer
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