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<br />1 I' <br /> <br /> <br /> <br />d <br />ltk S Dv <br />I OCUhev <br /> <br />tleld <br />State fL 3?/5t./d-- <br /> <br />3. Owner Information: Name <br />Address l.; 30Ci Si Ivw <br /> <br />Interes t in Property: <br /> <br />Name of Fee Simple Titleho der: <br />(If other than owner) <br /> <br />111111111111 11111 11111111I1 11111 1111/1111I11111 1/1/1111I1111 <br />2005218746 <br /> <br />R..;\.,.4. <br /> <br />" <br />-, <br /> <br />i <br />Address ~ <br />Contractor: Name -:-i1::q-VOO I <br />Address . PO 00Y S~._D <br />S. Surety: Name , + <br /> <br />. , <br />i <br /> <br />City S~~ <br />UV1*,a.~ SV\0 <br />City 2qh\.(~tlllS. State fL 3~3 €1 <br /> <br />. <br /> <br />Address <br />Amount of Bond: $ <br /> <br />City State <br /> <br />Rcpt: 933112 <br />os: 0.00 <br />10/14/05 <br /> <br />Rec: 10.00 <br />IT: 0.00 <br />Dpty Clerk <br /> <br />6. Lender: Name <br /> <br />Address <br /> <br />City <br /> <br />State <br /> <br />7. Persons within the State of F orida designated by Owner upon whom notices or other <br />documents may be served as provided by Section 713.13 (1) (a) (7), Florida Statutes: <br />JEO PITTMAN PASCO COUNTY CLERK <br />Name 10/14/05 03: 1!pm 1 of 1 <br />OR BK 664~ PG 604 <br />Address City State <br /> <br />8. In addition to himself, Owne designates <br /> <br />of to receive a copy of the Lienor's Notice as <br />provided inSection 713.13 ( ) (b), Florida Statutes. <br /> <br />9. Expiration date of Notice of @mnrencement (the expiration date is 1 year,from the date <br />of recording unless a differen date is specified.) <br /> <br /> <br />,20~. <br /> <br />Signature of Owner: <br />Sworn to and subScribe <br /> <br />Notary Public: <br />My Commission <br />PC93053048/A <br /> <br />'.~;i.d.1;nc Barn <br />/iDD157lJ i <br /> <br />t:,!".!!C <br /> <br />B()oded Thru <br /> <br />