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<br />3. Owner information <br />a. Name and address <br />Ahad Mahootchi, M.D., P.A. <br />P.O. Box 1059 <br />Zephyrhills, FL 33539-1059 <br /> <br />OR BK 6146 PG 1308 <br />2 of 4 <br /> <br />b. Interest in property <br /> <br />c. Name and address of fee simple titleholder (if other than Borrower) <br /> <br />4. Contractor <br />a. Name and address <br />John L. Smith Construction, Inc. <br />4240 Coats Road <br />Zephyrhills, FL 33541 <br /> <br />b. Telephone Number <br /> <br />c. Fax Number <br /> <br />5. Surety <br />a. Name and address <br /> <br /> b. Telephone Number c. Fax Number <br /> d. Amount of bond: $ <br />6. lender <br /> a. Name and address <br /> SunTrust Bank <br />'-"..\.. 211 Perimeter Center Pkwy <br /> Suite 100 <br /> Atlanta, GA 30346 <br /> b. Telephone Number 770 352-5221 c. Fax Number 770 352-5440 <br /> <br />7. Persons within the State of Florida designated by Owner upon whom notices or other documents may be served as <br />provided by Section 713.12(1)(a)7., Florida Statutes <br />a. Name and address <br />Heriberto Gonzalez <br />MC: FL-Zephyrhills-6011 <br />5435 Gall Blvd <br />Zephyrhills, FL 33542 <br />b. Telephone Number 813-780-4179 c. Fax Number 813-780-4170 <br /> <br />630417 (6/04) <br /> <br />Page 2 of 3 <br />