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Form b'la. l'C-18 I Re~~. 3-1-611 ,
STATE OF FLORIDA ~ -
FLORIDA INDUSTRIAL ~COMMISSION
TALLAHASSEE Account No. -
r'01'ICF. OF TAX LIEN Lien No._ C-l0e
- ~B 0 P A R D Y
Puz•suant to the provisions of Section 443.15 (3) (a), Florida Statutes, known as the Floi•ida LT~-
emplo~~ment Compensation law, notice is hereby given that there have been assessed, pt~rsuant to the
pro~isions of said law, against RobC2'! M. A11isOn t a AvaTd i~innin~„_3ximaing Pools
_ 1~1'~ South Federal Hig sra~v ~rt ~~a_e;__ Fiorsc~..~3450
an "emplo~•er" ]iable for the payment of contributions to the Unemployment Compensation Fund of
Florida, pursuant to the provisions of said law, the sum of covering the folluwing
contributions, interest and penalties, whicti after demand for payment thereof remain unpaid, and
that by ~~irtue of the above mentioned law the amount of said contributions (taxes), together with
penalties, interest, and costs that may accrue in addition thereto, constitute a]ien in favor of Florida
Ir,dustrial Comm~ssion upon the title to and interest, whether legal or equit~ble, in any real property,
- chattels real, or personal property of said emplo~~er.
Periods for which contributions, interest, and penalties have been assessed, and ±he ariounts
thereof, are as follows:
INTEREST THROUGH
tERIOD CONTRIBUTIONS ~ PEPiALT1ES
2nd ue~rter 1 65 108 ~5
~ ~N • . D~0
: = ~ , _ '65 , .
- , . • ~1C?~ )tiaJ
- ° _ R0~ R ~ ~r~as
_ . . ~ , I CC3UNTY,
, , _ . i
. -
~ TOTAL ~ 1W
~VITtiESS THE OFFIGIAL SEAL OF THE FLORIDA INlli:STRIAL C0~~;41ISSIOti and the hand
of the C}iairman thet•eof, at Tallahassee, Florida, this__ ~~___ciat~ of_ A~~ ~ , A. D. 1~'S
SEAL . ~
' ~s D• WI'~~1t.~ JT'• Chairman
Florlda Industriai Commisslon
COGK ~~V l.r~~
~