Claim of Lien

WARNING!

THIS LEGAL DOCUMENT REFLECTS THAT A CONSTRUCTION LIEN HAS BEEN PLACED ON THE REAL PROPERTY LISTED HEREIN. UNLESS THE OWNER OF SUCH PROPERTY TAKES ACTION TO SHORTEN THE TIME PERIOD, THIS LIEN MAY REMAIN VALID FOR ONE YEAR FROM THE DATE OF RECORDING, AND SHALL EXPIRE AND BECOME NULL AND VOID THEREAFTER UNLESS LEGAL PROCEEDINGS HAVE BEEN COMMENCED TO FORECLOSE OR TO DISCHARGE THIS LIEN.

Before me, the undersigned notary public, personally appeared , who was duly sworn and says that she or he is of , whose address is ; and that in accordance with a contract with , lienor furnished labor, services, or materials consisting of on the following described real property in County, Florida:

owned by of a total value of $, of which there remains unpaid $, and furnished the first of the items on , and the last of the items on ; and (if the lien is claimed by one not in privity with the owner) that the lienor served her or his notice to owner on by ; and (if required) that the lienor served copies of the notice on the contractor on by and on the subcontractor, , on by .