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aroperty Apprais~rs PuoN IdMtif'rxtbn (Folio) Numt~ris):
SPACE A/W~ TM16 lM1E FOII rROC~S3M8 MTA EtACE A~WE TMi LME f0l1 11[COIIO~iB DATA
~ ~ ~ ~1022961 ~46?~
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DOUGI i;'X~i!e ,
af ~1uri?ie~ ~ S 1 ~ '
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~mmt~ of
Before me, the undsrsiynsd Notary Public, p~nonally app~ar~d ~eC~~ ~-t ~f t t~J ?'1
who was duly sworn arsd says that h~ is (th~ li~nor h~nin) (th~ aq~nt of th~ lienor h~nin)
(DE~ETE ONE)
i he ~u+ ~ov5e O~ St~ l_.vc., e__ C~d un~y ,.~?~c •
(Lienor's Name)
whose address is ~~0 N, F~ I f~ J 1"f ~.G~I.I e r~ e, F(' 3~ 5! ,
(Lienor's Address)
and that in accordance with a contract with c K 3~~~e n ,
_ _ . _ _ _ ,
lienor furnished labor, services or materials consisting oi: (Qescribe specially fabrica:ed materials separately)
~ ~F-ub~e -t~:~ I e ~ Ret1~~L
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{ on the following described real property i~ ST. ~~,1X' ) e... _ _ County, Florida: I
~ ~ (Describe real property sufficiently for ideniifiCetion, including street a~d number, if known) {
i ~ ~o sc.N w~ t3 Rc~i ~ ;
~ ~g N~'~a o~ a 1 3 5 ~ou~h 3G ~Q sf .
~
:
fE
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~ I
s owned by f~ ~ ~K ~e-~rl
t-~ fvs
of a total value of ONE Nv+~r~. '~TW~~'?'~ t"O.U? d. bO/~dV dollars (S (~y• ~lJ ~~o' da _
~ • i~CO ~OS~}J
~ of which thsre ~emains unpaid =........~.~.,.~5,,,1 and furnishsd the first of the it~ms on '
~ ~.d.~ . 19 and the laat of the items on . ~.~..0~.~.1.9.~ , and (if th~ lien
~ is ctaimed by one not in privity with the owner) that the lienor served his notice to owner on ~ ~~9 ~ a~t
~
~ ~ ~ .,9~1~.bY !y~?~l a ~hone .
(Method of Service?
and, 6if required) that the lienor served copiss of ths notics on the contractor on { 1 I$ q'~' ~ a+ 9~'"
l~ ~ ~ ~ O
by ..~-IQQI..~..rt ~hQ.N~ . and on the subcontractor, .._~~GK 3ee~-en
_ _ _ _
(Method of Servics) n
on d ~ ,19`id,by MQI,L • ,
' ~i~U/~,' (Method of Service)
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~ C~J\`,. _J CG ~ThC Q~ ~vse of sf. (.ve ~e C~o~rl~c .
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e . : ~ ~ LIB~IOf
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Swom to and subscribed befare ms t is day of ~ g 7 ,
IS~OUGLAS DIXON, CI.ERK CIR. CT. /
St. lucis Counfy, FL ~~~,frl~~
BOOK ~75 PACE~~t~Q r.-~ , - " ~j ,
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