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<br />Penn It Number <br />Parcelldentific:atlon Number ;2 r"J-{, -,,2./ -0630 -OIKJOO-07.>(; <br /> <br />Prepared By: Team K Five Canst. Be Devl. <br />614 E Hwy 50 #320 <br />Clermont, FL 34711 <br /> <br />111111111111 1111I11111111I11111111111 11/1111111 111111111 1111 <br />2006218873 <br /> <br />Return to: <br /> <br />Rcpt: 1045716 Rec: 10.00 <br />DS: 0.00 IT: 0.00 <br />10/31/06 -______ Dpty Clerk <br /> <br />JED PITTMAN1 PASCO COUNTY CLERK <br />10/31/06 ,0 :2Jpm 1 of 1 <br />OR BK 724 I PG 10 <br /> <br />1. Description of property: (legal description of property, and street add..... If aj(~lIable) (J,' (fl'" I" c.I v1, ~t:.. <br />/J1~e.-~1i(, Oo.Jc5 Ca"'~VI1:7Y ,~p.,}l ()f1( pb3.5"~.s 1{)7-1I;l 'bTs 7S" rv I <br /> <br />3?Y~ ~vc$Ker R,J;,e sT <br />2. General description of Improvement(s) <br />/)"0 r + lAI,"c!d IV ~1..u~"'T <br /> <br />, WA~ttI <br />3. Owner Infonnatlon'M foe <br />Name ,~~:!"{n(2:. .5' ", ~ <br />Address '3.qLj 0 Qv-,,- ke f' I<. i ~e.. <br />'2e.PV\~""~\ \\ '5" I Fl. 33542- <br />4. Fee Simple 'Title Holder (If other than owner ahown above) <br />Name Telephone Number l( () 7 - Ss- '!:> 1-06 Oc.; <br />Address Fax Number <br /> <br />Telephone Number Q It ~_ 1 ~ g , I q '-I q <br />Fax Number <br />Interest In Property ~cY"\eo'-' t.!Je ~ <br /> <br />5. Contractor <br />Name Pf \I~ W'''.!,D....$ + bDor.s <br />Address 3s-0 s..~. <(3'1 w <br />lO""-'WbO), f/ 3.1 ., ~o <br />6. Surety {If any) <br />Name <br />Address <br /> <br />R' <br /> <br />Telephone Number <br />Fax Number <br /> <br />~;14- <br /> <br />,Telephone Number <br />Fax 'Number <br />Amount of bond $ <br /> <br />7. Lender (Ifany) <br />Name <br />Address <br /> <br />tv/'l1 <br /> <br />Telephone Number <br />Fax Number <br /> <br />8. Persons within the State of Florida designated by Owner upon whom notices or other documents may be <br />served as provided by Section 713.13(a)7.. Florida Statutes. <br />Name Telephone Number <br />Address !\I;1t Fax, Number <br /> <br />9. In addition to himself or heraelf, Owner designates the following to receive a copy of the Lienor's Notice as <br />provided In SectIon 713.13(1)(b), Florida Statutes. <br />Name fl/' /In,.. Telephone Number <br />Address I r, Fax Number <br /> <br />10. expiration date of notice of commencement (the expiration date Is 1 year from the date of reCOrding unle.. a <br />different date la specified): <br /> <br />/!lJJ~1. <br />Date S~~ . <br /> <br />$wom ~ ,ft. ...bqrtM .,.fo,. pt. this <br />W"rrt... (rJVraroe . <br /> <br />who Is pe..onally known to me OR <br />a8 identification. <br /> <br />r- ~---- ,.' <br /> <br />/ Ignature of Own.[Note: per Section 713.13(1Xg), ..o~r....... <br />8ign ...and no one elae may be pennltted to "'gn In his or Iwr " <br />stead."] <br /> <br />~S1J., dayof (}LTtbr <br /> <br />II prodUOecl rl/)L <br /> <br />:20P( <br /> <br />~ <br /> <br />: <br /> <br />Fonn Revised: 3/98 <br /> <br />~~~ T1MOTH Y ROLAND O'MALLEY Jgnature of Notary (notarial seal to appear below) <br />"A.9. '"' MY COMMISSION '* DD4S8845 <br />~0IV1."~ EXPIRES: Aug.7,2OO!I <br />(407) 398-0153 Florida Notaty SerIIlcacom <br /> <br /> <br />.'. "$.." <br />, ~;". .~J""~ . <br /> <br />: <br />