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Form E'la. l;C-181Re~. 3-1-611
• STATE OF FLOR.IDA
FLORIDR INDUSTRIAL COMMISSION
~ TALLAHASSEE Account I~o.
~tOTICE OF TAX LIEN Lien No. ~1-644
Puisuant to the provisions of Section ~143.15 (3) (a). Florida Statutes. known as tlie Florida Un-
emplo~-ment Compensation law, notice is hereby given that there have been assessed. pursuant to the
pi-ovisions of said law, against w~~ g? a~r~ - ~
- ---Ros~te-~-Ba~-
an "emplo~er' liable for the payment of contributions to the Unemployment Compensation Fund of
Florida. pursuxnt to the provisions of said law, the sum of covering the following
contributions, ~*_+terest and penalties, which after demand for payment thereof remain unpaidt and
that by virtue 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 lien in favor of T~lorida
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 penalties have been assessed, ~and the amounts
thereof, are as follows: ~
INTEREST THROUGM
rER10D GONTRIBUTIONS ~~~~7 PENALTIES
1 15 ~ l
ST. LUCIE OU~ Y F ;
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CL~RK CIR tJIT OURT ;
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WITNESS THE OFFICIAL SEAL OF THE FI.ORIDA INDUSTRIAL COMMISSION ai~d the hand ~
of tbe~Chaf~pn thereof, at Tallaha.ssee, Florida, this~Q-day of , A. D. 19 67 ~
~ ~
~ ~ ~ ~ "~~5. ~ This instrument
1' = vas preparee by
_ /
s;~ ~ ~ ' ; B„sTer j . _
- _l~rsr ~
- ~ : - • • ` Florida Industrial Comaiiasiotf ~
: . : E's ~ Cald11@ll 6uilding Flor I ri~ mmiss~on
- : Tal la~assoe, Florids 323C9
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