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g7, t.UCIE CO N
RR~ORD NE~~~Da7`~~-
STATE OF FLORIDA
ROGER POITRA$ FLORIDA INDUSTRIAL COMMISSION
Ot`ERK CIRCUIT COURT TALLAHASSEE Account No. 1~6172,A
NOTICE OF TAX LIEN Lien No U-628 _
JEOPARDY
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 Jamea Banketaa ~~'y Banketaa ~ 'Diaoaa 8
(}eraldin~s Banketaa as co-partaera ?~A Bury Ann' a Bakery
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 $ x•85 covering the following
contributions, interest and penalties, which after demand for payment thereof remain unpaid, and
that= by virtue of the above mentioned law the amount of said contributions (taxes), together with
penalties, interest, and casts 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 penalties have been assessed, and the amounts
thereof, are as follows:
INTEREfT TNROUGN
PERIOD CONTRIOlJT10Nf 6~ PENALTIEf
TOTAL ~/ I ~ ~ W
WITNESS THE OFFICIAL SEAL OF THE FLOP.IDA INDUSTRIAL COMMISSION and the hand
of the Chairman thereof, at Tallahassee, Florida, thi~16..-day of .~T»>v A. D. 19 6~
SEAL
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Flon'~ilnq/strial Commission
This instrumcrrt prcparcd by:
,may 1[. Ba:'Der
Florida Industrial Commission
C/rldlucll Bldq., Tallahasscc, Fla.