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<br />., <br /> <br />OR 81< 4377 PG 666 <br />2 of 2 <br /> <br />5 (a). NAME / ADDRESS OF SURETY 6. NAME / AODRESS OF LENDER <br /> CORNERSTONE COMMUNITY BANK <br /> 6518 4th STREET NORTH <br /> ST. PETERSBURG, FL 33702 <br />5 (b). AMOUNT OF BOND <br />$ <br />7. Person(s) within the State of Florida designated by Owner upon whom notices or other documents may be <br />served as provided by Section 713.13(1)(a)(7), Rorida Statutes are shown below: <br />7. NAME / ADDRESS 7. NAME/ADDRESS <br />8. In addition to himself, Owner designates the person 8. NAME/ ADQRESS OF ~N to RECEIVE COPY OF UENOR'S NOTICE <br />whose name and address appear in the box at the <br />right to receive a copy of the Uenor's Notice as <br />provided in Section 713.13(1)(b), Rorida Statutes. <br />9. Expiration of date of Notice of Commencement (the 9. EXPIRATION DATE <br />expiration date is 1 year from the date of recording <br />unless a different date is specified) is shown in box at <br />right. <br /> <br />NOTARIZATION <br /> <br /> <br />Signature <br />of Owner <br /> <br />STATE OF FLORIDA <br />COUNTY OF Pasco <br /> <br />The foregoing instrument was acknowledged before me this 30th day of May, 2000 <br />TiIoothy A. Kosloski and Melissa M. Kosloski <br /> <br />who is personally known to me or who has produced F I..- ~y \ -..J..Jt : s Ltc...:..V\.S0 <br /> <br />by <br /> <br />as identification. ~:, ~r::~/~~~_~{9:}1":~:"';:J <br />I"~-"-"",:?"'I'\ ~,i'\,c":,,..l ~,'.>... .',. ~ <br />(~(i~~I{i;6)~) 3~nded E~C~~;;'~'; i~3 . <br />My Commission expireS<>. "~/ / No. C -~ -' I D <br />'~ 11~K.- 1101h., <br /> <br />t1~ <br /> <br />Notary Public <br /> <br />(Seal) <br /> <br />. <br /> <br />WHEN RECORDED RETURN TO: DRAFTED BY: <br />Comerstone Camnmity Bank ~. Abel - Cornerstone Camnmity Bank. <br />6518 4th Street North ADDRESS, CITY, STATE <br />St. Petersburg, FL 33702 ~518 4th Street North <br /> ~t. Petersburg, FL 33702 <br /> <br />~. GREATlJIND 1995 <br />ITEM 71071.2 (9511). FLORIDA Page 2 of2 pa~ <br /> <br />GREATLANO . <br />To Order Call: 1-800-530-9393 CFax 616-791-1131 <br />