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9IT.17h, CLERK O`
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PERMrr NUMBER:
The undersigned hereby given notice that improvement will be made to certain real property, and in accordance with Chapter 713,
Florida statutes the following information is provided in the Notice of commencement. J
1. DESCRIPTION OF PROPERTY (Legal description and street address) TAX FOLIO NUMBER: 3534-501-OD49-000-2
SUBDIVISION BLOCK TRACT_--J,OT BLDG UNIT
REGENCY ISLAND DUNES BUILDING 1 UNIT 1001 (OR 40T7-57)
2. GENERAL DESCRIPTION OF IMPROVEMENT: 4NJJ fUn Kiff 0.
3. OWNER INFORMATION: a. Name Bertha A Quint (TR)
b. Address 8650 S OCEAN DR. #1001, JENSEN BEACH, FL. 34957 c, interest in property Owner(s)
d. Name and address of fee simple titleholder
4. CONTRACTOR'S NAME, ADDRESS AND PHONE NUMBER: Coom emswalrn im Po m. t3te Jensen �6 P Nathan coop 772-53aoesg
f
S. SURETY'S NAME, ADDRESS AND PHONE NUMBER AND BOND AMOUNT:
6. LENDER'S NAME, ADDRESS AND PHONE NUMBER:
7. Persons within the State of Florida designated by Owner upon whom notices or other documents may be served as provided by
Section 713.13 (1)(a) 7., Florida Statutes:
NAME, ADDRESS AND PHONE NUMBER:
8. In addition to himself or herself, Owner designates the following to receive a copy of the Lienor's Notice as provided in Section
713.13 (I)(b), Florida Statutes:
NAME, ADDRESS AND PHONE NUMBER:
9. Expiration date of notice of commencement (the expiration date is 1 year from the date of recording unless a different date is
specified) 20_.
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O UWhl2
Signature of Owner or Print Name and Provide Signatory's Title(Office
Owner's Authorized Officer/)irector/Partner/Manager SCANNED
BY
State of Florida St. Lucie County
County of &14jn / � `
The foregoinginstrument was acknowledged before me this 7-0 day of �J , 20 f 'S
By acr J'r-• QJ'...'{' ,as Ot"rJPt�✓L
(Name of person) (Type (Type of authority... e.g. Owner, officer, trustee, attorney in fact)
For se- i -r
(Name of party on behalf of whom instrument was executed) Personally Known or produced the following type of ID: —
e n k69L16 86 oZ//y��yr
(Printed Name of Notary Public) (Signature of Notary Public) (Se, a,,,, WALTER D PAYNE II
NP,
Notary Public - State of Florida
Under penalties of perjury, I declare that I have read the foregoing and that the facts in it t best otimyntsobstd0fiS&H67
belief (section 92.525, Florida Statutes). y+7,.° My Comm.Expires Aug H,2021
� Bondedlhrough National Notary Assv
ignatuur1e(ss)) of Owner(s) or Owner(s)' Authorized Officer/Direct�or/Partuer
By: '�i'Y By
a... oanarzaortRuowns)