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~ ~T Geputy Clerk
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Ptoperty Appnisar; PorCel IdantNication (Fol'q) humb~(s):
rr- S?At~ AsOHE TMIS LWE F011 ?i~SEL1A dT~ lNPl ~~ffK Tuut ~ Wt pf~ ~iAf1M~N NT1 ~
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• Before me, the undersignsd Noury Pubiic, p~rsonally sppsar~d u ~~n V~r1~1 T~1 ~
a
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who was duly swom and says that he is (ths lisnor htr~in) ( '~.h~~
-r t ` (DELETE ONE? , r D ~
.J O~ R ~J.J. U e-hc~ ,~IL.. V erY~;,-~"~; J a i n~ ~ n~9
(Lienor's Name) ~
7
3 S! ~ s w ~ o s~- F-~. ~,a~d., fi~ 333 . '
whose address is ~
(Lienor's Address) ~
and that in accordancs with a contrsct with 5~9 n ~TO /'h{„S ~
, ~
113~~ For~~__ ~.~~~e G--7~ W. Pa~M 1,3e4ch, F~~33~J~y. ~
lienor furnished labor. services or materials consisting oi: (Describe speciatty fabricated materials separately) ~
Pc~~+n~:r~ ~hrGe Sir~s~e ~a.+.i ~orweS inSic~le ana~ oJ~-'. ~ots 1,~,3. ~
2, Po?:n~:~ ~r~~all~ 3 vn~~. ~ownl~ous~, ~31d. l31d R ~
,
3, Mw~cr;als cons~s-~Qd of y~~ gc~ltor+s of' pa; n-4- c~nd Sl5 d ayS /oloar
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~ on the following described real property in v~. f~ (fC! e. County, Florida: ~
f (Describe reai property sufficiently for identification, including street and number, i! known) ~
! 730 ~ Ma?~sl, 1.c?nd.~ Ter'racZ ~ , ;
i ` 72 7~l 7~ 8,3 Ma~s?, la~d,~~ ~
7303 ~"~A~~ ~.a.,d:.~ Tt~~. lzr~ ~
~ 7305 Mw~s~• l,anc~?;ns Tcr~cG { ~
~ -730~ t~ ~
~ owned by ~S ~_Cyh ~o,~es ~'ohn l)~ 9
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~ of a total value of I~U~~en ~~V,TA~ ~~k/~ ~~?df"EC~ $1 dollars (S ~T
J 7~ ~
v ly,..7..~D
~ of which thero romains unpaid S.... . and fumished the first of the itsms on
~ 19 and the last of the items on ...1 ` 3 ~ 9~Q
- _ , and (if the lien
~
~ is claimed by one not in privity with the owne?) that the lienor served his notice to owner or.
~
~ ~ 1 Z~ . 19 g/, by rl'A/'~ C~ / l/C~'1/ .
(Method of Service)
and, (if requiredl that the lienor served copies of ths notice on the contractor on /~-~3~.$C~
by 1TC~r1d DeI ~ve ,~nd on the subcontractor. . / V~.
(Method of Service)~
F ~~~a~ ~ on '9 bY (Method oi Service)
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~ ~i , ~ • LienOr
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; 1S~ ' . ~ By
~ ~ i r Agent
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~.s i Sworn to and subscribed:bsfpre rite'thi3......... day of ~Qh(~Qr' ~ g~ '
_ ~
~ 1lOTJUtT 91J~I.IC.ST#1~ ~9F FLORIDA . !
MY CpMiSSION fXP. 11AY 31.1993 ,~Q~Q~ ~'i ~
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