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Dnputy Clotlt
Tn~s ~~u~~~»~x ~.v.~.o -~?cho~d 5(~ ~o~n , f..;~ i.~..~
~5t 5w Fo~ (3ro~.~n Rc1 ~0 JAN 22 A10 :Ay
s~nd~an~ow~. c? 3tiq5co ~ 102 02 9 2
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Propertp Appraf~rs PuoN Id~MNfCation (Fdb) Nurnbl~r(t): ~ 1 t±>> : N; r
sr+?cE iuo+rE n~ u~ w~ r~o~e au irACf MOME il~ UI! r011 IIL~~ OATA
(~l~ttllt iY~ '~t~Yt
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8efora me, the undsrsi9n~d Notary Public, p~rso~alty app~~r~d ~~r ~ o`~'N ~
who wes duly sworn and says that h~ is (tM lisnor Mnin) ~ ~
(DEIETE ONE)
C~i ~'T ~ S • ry/ ~
(lieno?'s Nams)
whose address is ~lfs~ ~n/ t- ox ~,rown ~r d Znd ~qr~~-own, 3yq5~o
(Lienor`s Address)
i ~
and that in accordancs with a contract with ~1C~ In ~U~'1STrl~C~l~n j~0~+- SC~{ ~1C.
.J
Por~ S~ Lucie , F ~ _ _ _ .
lienor furnished labor, services or materials consisting ot: iDescribe specially fabricated mate~ials separately)
C~ne~or~o~ Ren~a1 ! mon~h@ ~3a5.oo
~
~ on the following described real property in. ~~l-~C 1~..° t"Ql?1~~ County, Florida:
~ IDescribe real property sufficiently for identification, including street and nl~mber, if known)
~ ~~-t a~G ~31~k ~~355 S~~ yC) Chcar~es-~on S~
~
f par-~ ~S~ Lv c~ e~~ 1
owned by ~li n V ~~~Ct,. ~n~
~
k
~ of a total value of A dollars (S ~
f
F
~ of which tfiere remains unpaid ~ ~!C.F~. ~ Q.~. • ~ . • • . • . ~ - • ~~d furnishsd th~ first of th~ it~ms on
~
~ 2.' ~ 3_ . 19 .5~. and the lasc of ths items on J..- .~J q~ and (if th~ ii~n
~ is ciaimed by one not in privity with the owner) that the lienor served his notice to owner on 1~
~
€
~ .19 .by .
(Method of Servicel
and, Iit required) that the tienor served copiss of the notice on the contractor on
bY .}-~(an[~. .~~l.1~.~.°.C..... . , and on th~ subcontractor. . .}-~Q~ .1.~~.1~1~°!
, (Method of Ssrvice) T `
on ~Q(~ ~.2. ~ . 1 ~'~J , by !J'lr°! ( ~E ~ .
~~o~~yry~, (Method of Servicel
'~.e~~ C'p~ ~i'~`~
`i C?J ~ L~enor
! OC ~ --S
i ~ ~ t C/)
€ ~ wc ~~~St'QP~~~ SY Ag8nt
' ~~f COUNT't ~ 4
Sworn to and subscribed be s.....G~-~"- day ot 19
DOUGLA DIXON, C qR, ~L
eaa~ 67~ ~c~ ~1~7 ~''~°~~Q~~'
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