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3.Owner(s) name and address: — v `- L _ <br />Interest In property: 4_ L rat ; (� <br />Name and address of fee simple titleholder, <br />4. o ractor's name, acj4ress and nhone number: <br />5. Surety: (Payment bond required J)�wner frorp contras r, if ny) <br />Name, address and phone ..��nu�Qor: <br />Amount of bond $ `TJU �I S . � � (d <br />6. Lender's name and address: 1\iM 4..J <br />7. Persons within the State of Florida designated by Owner upon whom notices or other documents may be served as provided by <br />Section 713.13(1)(a)7., Florida Statutes, ` <br />ame, and pu enuJmber. <br />10 Z4 8. In addition to himself, Owners designs es the following person(s) to receive a copy of the Lienor's Notice as provided in Section <br />713.13(1)(b), Florida Statutes. �� /�� <br />e, ddress d phone umbefi <br />9. Expiration date of this Notice bf ,Commencement: �j : 'j C( 2l <br />(the expiration date Is 1 year from the date of teoo WV Less a different date Is aped" <br />WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENTARE CONSIDERED [ CC <br />IMPROPER PAYMENTS UNDER CHAPTER 713, PART I, SECTION 713.13. FLORIDA STATUTES, AND CAN RESULT IN YOUR PAYING TWICE FOR <br />IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE <br />FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK <br />OR RECORDING YOUR NOTICE OF COMMENCEMENT. <br />Signature(s) of Owners) or Owners)' Aut orized Officer/Director/Partner /Manager <br />Prepared By Prepared By <br />Print Name Print Name <br />Title/Office 1 Title /Office <br />STATE OF FLORIDA -� <br />COUNTY OF Miptrum ADE f� _\ _ � >� -�- <br />The foregoing instrument was acknowledged before me this day o C7tw� �,S <br />O lgovidnalty, or d as for <br />S'Personally known, or O produced the following type of kientifi lion: <br />Signature of Notary Public: <br />Print Name: e-- <br />LIMA (SEAL) NOTARY PUBLIC <br />VERIFICATION PLRSUANT TO SECTION 92,525, FLORIDA STATUTES STATE OF FLORIDA <br />Under penalties of perjury, 1 declare that I have read the foregoing and Ct mm# FFD40316 <br />that the facts stated In it are true to the best of my knowledge and belief. E) re4 7jMOi7 <br />Signature( o Ow s) o )'s Aut orized Officer /Director/Partner /Manager who signed above: <br />By By <br />