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RAMCO FORM 120Ya I,
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B~ton m~, tM u nsd No ~.~.....4.~.... ,
nd~nl~ tsr~ PuWb. P«'sawlh? ~PP~and
who wss duly swom and sa~?s that M Ia ( in) (shs~nt ot tM tiMOr h~ni~) . . . . . . . . . . . . . . . . . . . . . . . . _
. tl~ELETE ONE)
. . . . . . . . . ^5.7. R-RT...... S~ .A..~.....~ . . . . . . . . . . . . . . . .
t~i.+~or: N.m.)
whosa address is . . . . . . 4l.... ...!~.a . . . . . . . . ~ ! . } ~~1~ . ~~t. . ~~'1-
(Li~no?'s Addr~ss!
and that i~ acoordanc» with s c~wact with .Y...O .N. ~ ~i4N/V.....~.......... . ,
..............-~°o. r.~ .
lienor f~mishsd labor, s~vicss or materials consisting of: (Describe.specia!!y fabricated mate~idls se~srately)
?"o Fu a? t s rt ,g ~v ~a L ~ v E~
~f SD S y,~r • o~ ~8 ~4 f-1 I~4 So
on ths folbwing dsscribsd roal property in t~..~..l..~........................ County. Florida:
(Oe~cribe rsat property wificiantly for identificatio~, including strest and numbar, it known)
L oT ~/3,~ot/~ 3/1 ~o~~r. -Sr. 1 v~a~
s~~r/or?
~ 8~ 3 S, E, Cr fe o v~~?1 E., Pr. s-r.,[ v~ ~F f F~. .,~35~s,,~
ownedby....~a_i~.~.~-.~.. ,M..~......°~'....~..o.A.NN.......R..........FdoT.r
A -
~ J X T Q~ ~ /TN ~3/~d. G......... dollars IS ......b....~.
of a total value of . ~
of which tt~are remeins unpaFd s and fumished the fint of ths it~ms ~n
.1..'.(~.IQ.e...-~-...... . 18 ~.SP..._ snd the Isst of the itsms on ....~,t~'./Q.~...~
J...I~.. ..8.~....., and (if th~ tiM
~
is claimed by one not in privity with tha owner) that the lienor served his notice to owner on
. 19.........., by............../•~!--. .
IMethod of Service)
and, 1~1 required) thst the lie~so~ ssrv~d copi~a o# d» notics ~n tFw contractor on
by and on th~ w4contractor.
(Method of Ssrvics) • ~
on . . 19.........., by-•--.............---..... , ~
1Method of Service)
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S.r~,~.R..-.....~'o. o... : • .
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gy ~~...0,. . . . . .
~.o.~r~y P~ES,
Sworn to and subscribed before me this......... J..~`.'K.......day of V/.1~. .~G...-..... 1S.
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^ Notary Publ~c • _ , .
~ iis ~es~runtNnt prc~parc~d by: ,T , w. /~j u E~ L iOiARY 0Y(BLIC $T{~TE I~,f ~16K
.4ddr~s.~ P O. ~ e x o~ O 7 II J~t-c~ A RT ~4 . 3,,~ rY'5~~~ ~~°ocERE~ti~ [~ia~ f4. _
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