HomeMy WebLinkAbout0979 9U1~34 ~ ~ ~
HAMCO FORM 120',
~LA INO YICNAMiCi ~ • , .
UfN U1W ff )t~0~
~tt O{ ~Dit~2l ~ `
Qlaiad~ of I
Befors rns, ths undsrsifln~d NoUry Pubiic. p~rsonally epp~ar~d t'~`~~ y; r~' ~l J ~
who was duly sworn and says th~t hs is (th~ ti~nor h~t~in) Ith~ ~p~nt of 3h~ li~nor h~r~in?
(DELETE ONE)
t,' y ; ~ . ~C ,~~j;'!) i~ ~',A 5 A,G'<<' j4' f~ !?G c. s- f i 11 ,1. ~
(L~snor's Name) ,
whose address is ' ~ j; .~1,(. ~ c~ ,A~ ~ , r^'~ r~/F/,~~ C- ~ . , t/ /.j .
~
(Lienor"s Addressl #
. ~ ~ -
and that in accordanc~ with s contract with L'~f f' T /t .
c
i
lienor (umished labor, services or matenals cons~sUng of (Desa~be specially tabncated mater~als separately! 's
f~-i ;1 ~/t,'°};%./,' /'cL~C+f ~~~/}l~!'c~ ~!X ~ ~~RrS ' a, I~J~T~' I~•: ~~1~5 f
I :
~-~i T~"~4~1 ~~S ~ ~
~ ~
on the followmg descnbed real property ~n 7 r County, Florida
(Descr~be real property sufticiently for ~de~hficetion. including street and number, rf knownl
i S~,C- 4•~ t;,[~ ,t/ ;7:h j j, t t /~IFi~'~E~ i.~1~r.~7,~ yv'~-i~~-i;'~'%~-v
~ ' ~;~~~~~;Niv„ ~'...G~: F~C
~ ~f,F-E-n f~~~~.~.~-s .1 . • ; _ _ : ~ ~ , r~ :..~~rrt
f r h.2 ~ i. ` y
C i,fil - L•- i . ~ -2 ~ ~ c' ~ iL' ; 1 S~~ ~c . ~ 1~ ! ` { L ` . ~ ~ - i . .
S r.. t
~ T¢?q t~ a j t 4: r. ,xi~ ra ~ L L
~ti A~y~?7~' ~~Fir C~.aKT~~E' c~f%.•_!'Ilf~:. FS ~tr O t,~L~F H/ ~ y.
~ i',F~I ,,..~I1
k owned by I` ~
~F~ T ` ' ~ .'i_'~F !
~ ~ r : ~ li
~ of a total value of dollars tS 1
y
f ~
E ol wh~ch there remains unpaid i . and fumishW th~ first of th~ ~t~ms on i!
i ~
j ~ . 19 and the last of the itsms on . and (if tfi• ii~n ~ I
~
~
E K '
! { !s cla~rneti by one r.ot in pnv~ty v~~th iFie ow~er) that thg I~enor served his notice to owner on ~ i
~ ( ~
~
~ 19 , by
` (Method ol Serv~ce! i
~ an~f. iit reqwred) that the Icenor ssrved cop~os of ths nouca on tha contractor on ~ ~
€
i ~
~ ~ br . and on the subcontractor,
` (Method of Serv~cel , •
! ~1
~ r: on 9~ _ . 19 by ~
~ °i IMethod of Serv~cei `i
~ 1' l.~ ~ P~ ~,,l,n rt ~,i~..,~, _ f-._~L ,i
~ • Lienur ,
~ BY i-~'.~ =`I f~^. /fr~,
_ J ~
~ Age~t
S ~
~
~ Swnrn co and subscr~becS before me this ` day of 19~~
y :
i ~ ~
, ~ , ;
` ~ Notary Publ~c
~ lli,• ln•~,,,r,r, r,, ~„~•~,~rr, ~l I„ L'~ ~"-~'K ;
l~l,h,~.• liotary PubC~, Staie.of fioada. '
M~t Cw:u~:~:~:o~ ~x~tas Aar~ 2d. 1991 ~ ~
M~Mi i N. S ru t{~t ' Y~te~*~'? ia.
~ 90123~ ~
i
i
; 'Y,8 -1 P 2 ~24
~ :
~ ' 1 y
S ~
~ t UV~U'..r . ~
~ ST. ~ t,~: . ~
:
~
_ ~
~~R~ 593 ~~f ~79
x
s , i 'i _ - n''#
~ ~~P ~~~~:~-~~~~`~~;~°-~'.~'"~~~~~M