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• 146?5~22
Form Fta. UC 18 fRe~. 3-1-61)
~ STATE OF FLOI~IDA
FLORIDA IIvDUSTRIAL CANIIVIISSION
TAI.I.AHASSEE Account xo. ~
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NOTICE OF TAX LIEN Lien No 4'~
~rsopaaai
Pursuant to the prnvisions of Section 443.15 (3) (a), Florida Statutes, known as the Florida li~-
employment Compensation law, notice is hereby given that there have been assessed. pursuant to the
provisions of said law, against a~ K~~ (A Floo~'!As Oo~poo~ltti,on)
P. 0. Doat 3566 ?t. Pi~~~ tl~'ida 33~3b
an "employer" liable for the payment of contributions to the Unemployment Compensation F~nd of
Florida, pursuant to the provisiona of said law, the sum of covering the following
contributions, intereat and penalties. which after demand for payment thereof remain unpaid, and
that by virtue of the above mentioned law the amount of said contributions (taxesj, 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 leg?at or equitable, in any real property,
chattels real, or personal property of said employer.
Perioda for which contributions, interest, and penalties have been assessed, and the amounts
thereof, are as follows :
~wrswcsr niROUaM
KlIIOD CONTRI~UTIONf ~ PENALTIEf
i.~ Y ~ 1 . W ~ - ~
oEo
• C, COUNT • ' y
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: 16 ~
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TRAS
' aK ~RCUIT
TOTAL W ~ ~
WITNESS THE OFFICIAL SEAL OF THE FI.ORIDA INDUSTRIAL COMMISSION and the hand
of the Chainnan thereof, at Tallahassee, Florida, thi~.l~day of ~ A. D. 19 ~
.
SEAL • ~ i'` _ ~
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: o - ~ . _ : ; - J. D. Nrlgirt, Jl~. c~w~
: " - , , t' - tz , . Florlda Industrial Commisilon
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