HomeMy WebLinkAbout2728 ~3eturn to: (onCbs~ saM-~ddnss~d stsmp~c! snwbp~) ~ c,J
~u? iNO?~[CNwNit~ •RA1u1C0 FORM 120'~
ucM tww. ~s ri~oa
r'~' 1022959
~x... . ~ - - . _ , _ . ~ .
e it~ _ -
• ~l.iw W
~ ~J Deputy Clerk ~
~ Total i ~•~-•-r
rn~s insaument ~puod by: Le ~ npr
.
~1~ N K~ ~;y
~~erce 3yq S 1 ~
Property Appraisors ParCOI IdontifiCatiOn (Fplip) Nurt?b8~r(s):
a~ awrt nwa ur~ ~on moc~sswe a?z~ u~ ~ nrs ~~~oo~aeB au
'90 FEB -1 P 3 :45
~l~tln '~~t.~n _ 10 2 2 9 5 9 ~t/
rilt~ .
Qf ~luri~tt n ~ U G~~+: X ~ h.~ ~
o~~ S' f c N;;.
QIauitt~ ~f ~
Befo~e me, the undersigned Noury Public, p~rsonally appNrsd ~e~e ~ t~ v(~~`'t'T J n
who was duty sworn and ssys that he is (th~ li~nor h~r~in! (tho ~p~nt of ths lisnor h~roin)
(DELETE DNE)
-T he. tfl~+ No~sc COf ~-f- . L v~. ~ e. CQ~?~~-t-~ ~~n~
(Lienor's Name)
whose address is ~3V ~ ~ 1 V • ( \ ~ ~ ~ ~ " Pre rc e , ~ ( 3UGS 1
(Lienor's Address)
~
and that in accordancs v~ith a contract with ~,i„11'1 ~ ~ ! ,
l ~
_ _ . ~
_ _ ~
lienor furnished labor, services or materials consisting o(: (Desc~ibe specialty fabricated materials separately) j
o r-r-a b~ Q, -~-~i 1 e-~ ~e.r~ -~c.~ ~ ~
I
~
; I -
; on the foilowing described real property in ~ VC-. 1 e_ County, Fforida: !
F (Describe real property sufficiently for identification, including street and number, if known) ~i
' ~-o~" ~3 81 oc ~ aa !
r Vr~~} ~~i ~e r~ ~ K
~ ~rrr~ ~ ~ So~U~• i
~ o~~,~, (~am ~ e, l_.r1 • j
F
~ owned by ~1 -
, i,~.) ~e
~ ~,1 V. r , p I P,.. s~• o0
oi a totat value of c..~v~ ~Jy~~QG~ 4- ~J~ ~ N ~ ~ ~ • ~ ~ ~eco ~ '
~ 'te'1 ~ ~ dollars (S ~ (O r,~1^~j ,
r
_ - .
f af which thero rePnsins unpsid S... _......1....!.~'.. and fumished the first of the itsms on
~ V .'..~1... . _ _ . 19 . and the last ot the itsms on ~ ~ d _ _ _ . , and (if the lien '
~ is claimed by ane not in privity with the owner) that the I~enor served his notice to owner on 1 d
f ~'gCl '
p
~ .,s .by MA~ L ,
(Method of Service) ~ I T~ e u /~~13 0
and, (if required) that the lienor served copiss of the notice on the contrector on ~
by h A~`-'a" PI~o r~_ and on the subcontractor,
_ . _ .
_
(Method of Service)
on .19 .by ,
(Method of Service)
~ ~T~ne ~-ti,vt~ E~~ Sf l,vC ~e ~.~x~
~
~ , ~~e~o?
~ ~ ~
~ ~ ~0 U,yTy B 1 ~
J~ • • CD Y Agent
~ ~ C' ~ '•.1 ~ .
Swom to and sub f~Ad~e~6r~ rr~ th~~ day ot 19 ~v
~ DOUGLA
~ ~3 5 DIX , CIER ti
~OR 7t~ FAGE~7~8 ,;ti:.,:,,--- ~ ~7 Sr. lucae C~~ ~
~ ~ : ~,~r ~!~1 r ,~~j ,
. ~
~ v~~` CI.~NiY ~ ~ _ _ ~ ,
- _ ' -
~
_ .w, - ~
` _ w