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Permit No. / - , Property Identification No . / V — ' - 2._ Z7 - 0 - 0 C' /0 ---0 - ZC o i (D C THE UNDERSIGNED hereby give informs you that the improvement will be made to certain real property, and in / O 4 : 3. .D section 713.13 of the Florida Statutes, the foil n informati n is r d m is O 1 OF 2 (903 , - 1. Description of property (legal description:) 0 3 v - LA ) - 4 1 fir% �r l4/ tJ LA) 0 V _C2 .,-(5.-• a.) Street Address: 38030 Hall Avenue Zephyrhills, FL 33542 /( r 2. General description of improvements: Replacement Window Installation. 1111111 11111 111111110 11111 11111 11111 11111 11111 11111 11111111 2010065469 3. Owner Information a.) Name and Address Donna Williams 38030 Hall Avenue Zephyrhills FL 33542 Rept 1304400 Ree 10. b.) Name and address of fee simple title holder (if other than owner) DS: 0.00 IT: 0 . 00 c) Interest in property Owner Dpty Clerk 05/10/10 C. Condry, R 4. Contractor Information a.) Name and address William Blaine Underwood 6910-B Breckenridge Parkway Tampa, FL 33610 b.) Telephone No: (866) 946 -3189 Fax No. (opt) 5. Surety Information PAULA S. O'NEIL, PRSCO CLERK & COMPTROLLER a.) Name and address: 05/10/10 02:49 m 1 of 1 b.) Amount of Bond: OR BK 838 PC 1734 c.) Telephone No. Fax No. (opt) 6. Lender a.) Name and Address Phone No. 7. Identity of person within the State of Florida designated by owner upon whom notices or other documents may be served: a.) Name and address: b.) Telephone No: Fax No.(opt): 8.In addition to himself, owner designates the following person to receive a copy of the Lienor's Notice as provided in Section 713.13(1)(b), Florida Statutes: a.) Name and Address b.) Telephone No. Fax No. (opt.) 9. Expiration date of Notice of Commencement ( the expiration date is one year from the date of recording unless a different date is specified): WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART 1, SECTION713.13, FLORIDA STATUTES, AND CAN RESULT DSF YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT. STATE OF FLORIDA COUNTY OF 7Q r MERRILL X ) $ WCODROW Signature of Owner or Owner's Aidhorized Officer/Director/Partner ner I Manager ,,, .. OMM!SSION # DD926676 ? r Donna Williams ; { o„p� : ::_.i:: Se 20, 2013 Flint Name (407) 398.01,E FioridallotaryService.00m /. The foregoing instrument was acknowledged before me this 28 day of April 2010 by ( n R N W r0 41 , , j 85 (Type of authority, e.g. officer, trustee, attorney in fact) for ( name of party on behalf of om nnstru ent was executed). // {f � / n Personally Known Or Produced Identification X Notary Signatu Q-_C '' _ ?t 1' " 4a! - ,- E %`� Type of Identific io Prod `Y � Till J &-J ' "U Name (ph print) 1/00 ;� ,/L - -0 I, ` eciep] 6 verification pursuant to Section 92.525, Florida Statues. Under of perjury, I declare the I have read the foregoing and that the facts stated in it are true to the best of my knowledge and belief. ( I r FORMS /J X i , J MOC,rvsd2007 �� in' /� �/�/��, Signetire of Nahral Person Signing Above Notice of Commencement Permit No