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• STATE OF FLORII?A ---~ '
F'~,ORIDI•~ INDUSTRIAL C~~/iI~SiON sT. l1~CIE~~~~~tr, _~~,
• TALLAHASSEE Account No._.~_
NOTICE OF TAX LIEN , Lien Nc._ L-t?5 -
Pursuant to the provisions of Section ~l43.15 (3) (a), Florida Statutes, Known as the Florida Unempluy-
mc~nt Compensation lacy, natice is hereby given that there have been assessed, pursuflnt to the provisions of
said la«•. against _- ~~ - --
an "employer" !iahle for the Nayment of contriLutions to the L'nemplor•ment Compensation Fund of Floridt•.,
pursuant to the provisions of said law, the sum of $-~ ~ ~ covering t!~e following contrib~~tions,
interest and penalties, which after deriand for payment thereof remain unpaid, and that by :irtu~ of the
ai,o~•e mentioned law the amount of said contributions (taxes), togethez• with penalties, interest, find costs
that may accrue in addition thereto, c~~~stitute a lien in favor. of Flo:ida Industrial Commission upon the;
title to and interest, «•hether legal or equitabt>?, in any real property, chattels real, or personal property of
staid employer.
Periods for which contributions, interest, and penalties haze been assessed, and the amounts thereof, are
as follows:
PERIOD
CONTRIBUT{ONti INTEREST THROUGH
PEN /.LTIE6
~ F~ CSR .
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'~ ST. IUCf~ CCUN T- F ORIDA --
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~'4'ITNI•:SS THE nFrICIAL SEAL OF THF. FI.OIt!DA II+~DUSTP.IAL CO:~i..iISSIO?v and the hard of
the Chait~i^ri,n thereof, at Tallahassee, Florida, this ~ _ day of ~}~b~r , A.D. 19 ~: .
~.r ~.,~~,~~ Chairman
=~~~ Florida Indt!stria! Comrt.iizsion
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