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Form F'la. UC-18 (Reti•. 3-1-61) ~ ~1
STATE OF FL4RIDA v
FLORIDA 1NDUSTRIAL COMMISSIOh ~
TALLAHASSEE Account 1vo. ~D~~
NOTICE OF TAX LIEN Lien No. ~•~3 ~
Pursuant to the pruvisions of Section ~~3.15 (3) (a), Florida Statutes, known as the Florida Un-
employment Compensation law, notice is hereby given that there have been assessed, pursuant to the
provisions of said law, against ~b~ ~tlield _
201 !?th $treat.?t. lierce. ~'lar3du ~~50
an "emplo~•er" liable for the payment of contributions to the Unemploy ment Compensation Fund of
Florida, pursuant to the provisions of said law, the sum of $ _ covering the following
contriUutions, interest and penalties, which after demand for payment thereof remain unpaid, and
that by virtue of the above mentioned law the arnount of said contributions (t~es), together with
penalties, interest, and costs that may accrue in addition thereto, constitute a lien in favor of Florida
Industrial Commission upon the title to and interest, whether legal or equitable, in any real property,
chattels real, or personal property of said employer.
Periods for which contributions, interest, and penaities have been assessed, and the amounts
thereof, are as follows: '
tNTERE$t THROUGH ~
PERtOD GdNTR10UTfONS tENALTIEB
' ' 800
'6 C~~ 30 : ~
, .:<<~. .L3~1(~~
~ :~•'~~Y r~.,, ~-,J OGE ~ i ~ a~.
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WITNESS THE OFFIGIAL SEAL OF THE FLORIDr~ INDUSTRIAL COMMISSION and the hand
of the Ghairman thereof, at Tallahassee, Florida, this~day of A. ll. 19
SEAL ~
: ' - • J • D s Chairman
; ,y ~ . ; di-ids Indastr[al Commteaton :
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" ~ 6a~x ~2~ 474
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