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144'710
Form Fla. UG78 fRev. 31-61) ~
STATE OF FLORIDA
FLORIDA II~TDUSTRIAL COMMISSION
TALLAHASSEE Account No. ~~11-~
~ NOTICE OF TAX LIEN Lien No.
JEOPABDZ
Pursuant to the provisions of Section 443.15 (3) (a), Florida Statutea, known as the Florida Un-
employment Compensation law, notice is hereby given that there have been assessed. purauant to the
provisions of said law, against ~ti ~d T~A 8~s
p-~. ~38~i,-~. Pi~;~,-~'1~ari~s 334s~
an "employer" liable for the payment of contributions to the Unemployment Compensation F~ind of
Florida, pursuant to the provisions of said law, the sum of $ covering the following
contxibutions. interest and penalties, which after demand for payment thereof remain unpaid, and
that by virtue of the above mentioned law the amount of said contributiona (taaes), 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 prnperty,
~ chattels real. or personaI property of said employer. _
~
i Periods for which contributions, intereat, and penaltiea have been assessed, and the amounts
~ thereof, are as follows :
~ INTEREST THROUGM
PERIOD GONTRISUTIONf ~ rENALTtE!
1 11 60 15 00
E RDE ~
o
.
P~ Z ' ~ -
~
1 4 ~
R~GER P pk1NTY.
ORI~A
ToTw~ 11 60 15 ~
.
WITNESS THE OFFICIAL SEAL OF THE FLOftIDA INDUSTRIAL COMMISSION and the hand '
of the Chairman thereof, at Tallahassee, Florida, this-~day of , A. D. 19 ~
SEAL - ; 8 Lf.'" - •
a. •
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- - - ~ ' ; ~ . ~
_ - - J. D. tiright Jr
_ . - Florida Indastdal CommUslon ;
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