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~ 155~l~
Form Fla. UC 18 (Rev. 3-1-61)
~ STATE OF FLOItIDA
~.o~A n~vs~ cor~nuIISStoN
TALLAHASSEE Account rTo. 128102
NOTICE OF TAX LIEN Lien No ='5~'
' Pursuant to the provisions of Section 443.15 (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 T/A Tl~ie Gcl,a
iiool!
P. 0. Booc 19Q, Pierce, lrl,orida 33~61
an "employer" liable for the payment of contributions to the Unemployment Compensation Fund of ,
Florida, pursuant to the provisions of said law, the sum of ; covering the following
contributions, interest and penalties, which after demand for payment thereof remain nnpaid. and
that by virtue of the above mentioned law the amouut of said cantributiona (tauea), toBether with
penalties, interest. and coats that may accrne in addition thereto, constitute a lien in favor of Florida
Induatrisl Commisaion upon the title to anii interest, whether legal or equitable, in any real property,
chattels real, or personal property of said employer. _
Periods for which contributions, interest, and penalties have been assessed, aud the amounta
thereof, are as follows : ~ ~
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E ~Nnaur ~ieouaM
~ ~Elt10D CONTRISUTION! rtNALT1Es
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CIERK CIR UIT OUR'C
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TOTAL
WITNESS THE OFFICIAL SEAL OF THE FLORIDA INDUSTRIAL COMMISSION and the hand
of the Chairman thereof, ~~.~nilahassee, F'lorida. this3~--daY of ~l , A. D. 19 67
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