33 Lewis NocAddress of property being improved: -3 -S. Ix f
General description of improvements:
Owner Lr n\%t
Address 3zwiL
Owner's interest in site of the improvement
Fee Simple Titleholder (if other than owner)
Name
Address
ContractorAC P4, —e t1 r�
Address 6l�Dl-
Phone No. %,�8'''�- r` Fax No.
Surety (if any)
Address
Phone No. Fax No.
L `-:� 7- 2--
R-- - -4:5-L '?
nt of bond $
Name and address of any person making a loan for the construction of the improvements.
Name
Address
Phone No. Fax No.
Name of person within the State of Florida, other than himself, designated by owner upon whom notices or other
documents may be served:
Name
Address
Phone No. Fax No.
In addition to himself, owner designates the following person to receive a copy of the Lienor's Notice as provided in
Section 713.06 (2) (b), Florida Statutes. (Fill in at Owner's option).
Name
Address
Phone No. Fax No.
Expiration date of Notice of Commencement (the expiration date is one (1) year from the date of recording unless a
different date is specified):
THIS SPACE FOR RECORDER'S USE ONLY OWNER
Siqned:n gam
DATE ` Wa
Before Me this 3iday of in the
County f Duv I, Stat74f FI 'd has personally appeared
Doc # 2020181348, OR BK 19335 Page 1757, f ill Mt "� herein by
Number Pages: 1 himself/ herself and affirms that all statemen s declarations herein
Recorded 08/19/2020 03:42 PM, are
RONNIE FUSSELL CLERK CIRCUIT COURT DUVAL E
kt,JENEENY. HAMPTONCOUNTY Commission#GG 941759RECORDING $10.00 .;<s Expires February 28,2021° ge�Jed Th1U Troy Fain Insurance 800 385 7019
Notary Public at Large, State of i, County of
My commission expires: r1ge-aLr YV o20 oZ _
Personally Known _! or
Produced Identificatirn _