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RAMCO FORM 120'i
iLA lt~p MECNAMICf' .
UEM tAW. if 7U.W
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Bsfora ms, the undsrsi9n~d Notary Public, p..sor~aiiy •pp.ar.d ~ .1. ~ N . J _ ~ ...1~-~. s. . :
who was duly swom and says that h~ is (th~ li~nor F»nin) (th~ ~~~nt of th~ li~nor ~ersin) V.1 L.l~ ~'~~.S.l'p!~N `
_ (DEIETE ONE)
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~~~0'2.. r0~'~~ck..._Q.) _.__~.~C~~,.~I~l0..4'... _
(Lisnor's Neme)
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whoseaddressis. Z~~.~ ~..._5..~..~1'f~"R-.~....._~..,.+ ...~.~.y9.~'-.~'.
(Lienor's Address)
and that in accordancs with ~ contr~ct with 1~-'~......N.?=V ~ l U~r'1 t N 1 Q-(~.~. .
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1 0 "1 ~S . .~.c. ~ .11... ii.~. ~.~v..S.7=.N. ..1~1~:1'~ ~ . .r ~ ....3.3 1 ~ . . . _ .
lienor (urnished labor, services or meterials consisting of: (Describe apecially fabricated materials separately)
Q~r4; ~1( ? m~o ~~i r'_~ L~} o fL r_ ~ s
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on the following described resl property in.....J..~..:..L,..t.iG~.k. County, Florida:
(Oescribe real property sufficiently tor identification, including street and number, if known)
)-~t..-3~-y~ N 30~. o-Z or SL~ ~ o~3.~z-~ l'~`~s
YY1 ~ fl 5 ~A Lr /~l f A o F G- o v~ l.._ c~ 2- L`~"
c~ r f~ 1 H 2• q o ~ c~ 1 1~ k. S~-~ k'~ Y~
i o N ~
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owned by ~
~ u ~~..~.t'~~ . ~Y-'.Y~4.N ...4-.0.~'. ,
ofatotalvalueof _ dollarslS ~..~.-1 V'.'"i.U _ '
of which there remains unpaid S...~..~....1..0.:.~...p...--•..-.•••••. and furnished the first of ths items on
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~ J.~.N......~. 2....... , 19 and the last of the items on ..~~~~-.~......~.~t'.,...~1G? and (if the lien
i is claimed b- ,,ne not in privity with tha owner) that the ~ienor served his notice to owner on ~1. ~ i`.
i
` ~ ~"l ,19~U%.by___~~N'~..__~r.~..].V~.'r:.l~-~.___ _ .
~ (Method of Service)
i ~ and, (if required) that the lienor served copies of the notics on the contrsctor on y'
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by ~/1~..~..~..:...~'.~. ~ .1..~.. . and on the subcontractor.
~ lMethod of Service)
~1~iZ ~ 1~_ _ 1 ~l _ _ _ . .,s.~6.lo.nv . ~N~fJ _ _ ~~/r_~i.~x 2~~_...
on
(Method of Service)
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~i Lien _ '
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{I B v`r _ ~ . . • -
~ gent '
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~ Swom to and subscribed before me this_...~ y of _ ~ 19..~.
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~ 7'hi.. In.+lruinrn! pr~~pru~~d h~~: .
- ~QTARY PUBLIC STATE Qf-FCORIOA
~ ~~~~~r~'.~.~ 111' COMMISSIOM EXP JUL~ 10~1989
~ AF~ - BONDEO iMRU 6EMERAI INS. UkU.
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