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~'o;m F'la. C'C'-1R iRe~. 3-1-611
STATE OF FLORIllA
FLORID~ INDUSTRIAL COMMISSI~N ~
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TALLAHASSEF. - Account 10..._ ~2~5~-~___
~TOTICE OF TA~?: I..IEN Lien :~`o._---8~~~7_
~ JEOPAItDY
Pursu~nt to the provi~ions of Section =1=13.1~ (3) (a), Flarida Statutes, known a~ the Florida t'n-
emplo~-ment Compen:ation law, notice is l~ereby given tha~ ~here ha~~e been assessed, ns=rsuant to the
pro~~isions of said IaH•, ag«inst ~i.~.H~._Snc.~_~A F1erl.oa--~~r~t3.~Il.~-~.`._______-.-----.___----
T~A Ann'~s R s~e?~t
14~ _ th Street, F`t._~'i~rce~ F1or3,da_ -
ttn "etnpla~•er" lial~ie for the payment of contributions tc the Unemplot~n7ent C~mpensation Func~ ~~f
~ loi•ic~a, pur•suant to the prot-isioris of said la«•, the sum of ___~6°~ covering tlie IO110~'lI7Q;
contrihutions, interest and penalties, ~a•hich after demand for payment thereof remain unpaid, and
tf~at ~ay~ ~•ir±ue of the .l~ove mentior,ed ;aw t.t-,e amaunt of said contributions (taxe3), tagether ~i-ith
penalties, interest, and costs that ma~~ accrue in addition thereto, constitute a lien in faror of Florid:.t
Industrial Cc~mrnis~ion u~~on the titie ±o and interest, K-het}ier leg~l or equ:table, in an~~ real prt7pei•t~~,
chattels real, or pet•sc~nai propert~• of said emplo~~ec.
Perio~ls f~~r whicll conti'1E>Lit1UT1S, interest, and penalties ha~•e ~,een x5sessed, and t}le amounts
thereof, are us follo~ss:
IN7EREST THRt7UGH
PERIOD CONTRIBUTION$ PEPlALTIES .
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_ 1~~ ~iart~r~ 8 00 ~ 43 .t~ 1Q 00
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' TOTAL ~ itJ~ G~ I ~F~ 1~
tt'ITtiESS THE OFFIf_'I~L SEAL OF THF FLOY.iD~ INDUS'1RIAL CO~S~lIISSION and the i~an~i
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of the Chairm~n thereof, at Tallahassee, Floricta, t.his__ u_day oi--_ J?~e D. 1~5
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. d. L. ~1~'1~ht J Cha?rman
- Florida Industrlal Commissfon
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