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HAMCO FORM 120'-z
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IiEN IAW. f~ 11~0~
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Before ma, the undersigned Notary Public, penonally appeared ~~Q~-- M.• H~AFIV c. r`
whrs wn~ ~1~lly syun?~ ~ne1 ~wv~ thsf Isw Ithg li~.,.si ~.1.~:.Z1 1~ w~ •
.~v.. ~....vu~~
(DEIETE ONE)
ECoN~o `1~ACTDR ~~RV~C.E. _ _ _
(Lienor's Name)
whose address is ~G'~.Tt~.~~~~~~ ~ .r Q ~4 ~ ~ ~ ~ , ~ ~
(Lienor's Address)
and that in accordance with e contract with N~-A N_. ~~~SS ,
_ _ ,
_ _ _ _ _ _ _ _
lienor fur~ished labor, se~vices or materials consisting of: (Describe specially fabricated materials sepa?ately)
M~~ o~ ~-r 30 3~_cc~. ~ sg 1~u-~- s-T i..a,~ ~ s~ c`nc~nl ~
on the following described real property in . ~--UC County, Florida:
(Describe real property sutficiently for identi(ication, including street and number, if known)
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1_.xCA~ t`~. ESc~~ ~oN ~
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~ 3~- ~ 5~' ~O 1.1~ i.ST. ~uC, i~. L.
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~ owned by J-1~..? N wl 1 Kt'tv
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~ of a total value of ~~.1 ~T y dollars (S a c. n o ~
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~ of which there remains unpaid S......~.C'.,..Q.~~ and furnished the first of the items on
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~ ~~.1.~.. ~ e~... , 19 .d...! and the last of the items on ( `~1. _ . . _ , and iif the lien
is claimed by one not in privity with the owner) that the lienor served his notice to owner on
~ ~ ~lVn~ ,19Q~.by ~I~~CT~ ~1L...
_ ~ (Method ot Service)
~ and, (if required) that the lienor served copies of the notice on the contractor on
bY ~v~' and on the subcontractor, 1'v/~
_ _
~ (Method of Service) •
on
, _ .~y _ ,
(Method of Service)
T: I ~C~'nlc -~c7t~ ~~?VEC ~
Lienor
BY C~Q,~~' 171. ~1.~ -x-~-
A ertY
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~ Sworn to and subscribed before me this ......day of U~~, ~g
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- , .:/...L~J?i~-f,t,~{,.! 7~ W "Yt-~ L~~ .
Notary Public
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