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~ ~ 186151 This Instrument was p~epared by:
S SiROME MN(MEII. Department Attorney
_ f.brid~ Depa~tment of PuDtic Welfare
AFFIDAVIT OF LIEN ON RF~L PROPBRTY Post pftice 8ox 2050
J~daonviYe. FloriGa 32203
STATE OF FLORIUA
COUNTY OF St. Lucie
. Before~me, the undersigned suthority, on this day pereonally appeared
Jenia Britt , Who being by me firat duly svorn,
deposes and eays:
That a he has this day applied for a determination of eligibility for pub~ic
a8siatance fran the State of Florida under the Social Welfare Act, Florida Statutes,
Chapter 409, and the undersigned affiant being the owaer of certain non-hcmeatead real
property, ~rhich would make the affiant ineligible for public aasistance vithout thia
affidavit creating a lien against the real property, and the affiant hereby declaree
the public aseistance paymente to be made to the affiant fran this day forward ohall
create and be a lien against the below-described real property for the full amount
of said payments. This lien shall be enforceable by foreclosure against eaid property
at the time of the death of the undersigned, or upon the death of the survivor of them,
whichever occurs last, if executed by ~nan and ~rife, or at auch time as affiant sells
or otherwiae alienates the land prior to her death. This lien shall be supexior to
all other liens which do not heretofore exiat against the following described real
property in St. Lucie County, Florida:
Lots 4 and 5, north half of the vacatad aZley adjacent on the aouth, White City,
in Block 38, as entered in St. Lucie County Deed Book #142, Page #135
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~ Affiant further represents that in the event of sale of said property be-
' fore the aforesaid lien is paid in full, 8
he will notify the purchasers in such aale
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of the existence of the herein-deacribed lien and that in the terms of the 8ale s he
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~ will require that the Department of Public Welfare be paid in full out of the proceeds
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~ of.the sale at the time of the closing of the sale.
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Deted this /9 " day of , A. D. 196
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~ Sworn to and aubscr~bed fore me Affiant ~
this dsy of ~k. ,
~ A. D. 196~.
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FILED AND RECOROEO
ST. LUCiE COUNTY. FLA.
~ ~ ~+~:COP,D V-RIF!~~
_ Notary Public 1$sisi
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~ Notary Pu5lic, StatP ot Florida at large '69 NOV 2 S PM ! 2. 0 2
~ My Ca~n: ~:;sicn Czo:res !~r.e 1~?, l~it ~
~w~'~. . ~ . Cuic~a r, ar._.. F.re . C:..r+i C~.. ~M~
~ ~ ~ ~ - r 7 Y ROGER i'OITP.t.S ,
~ ~ CLERK CIRCUIT COURT
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' 8ot~p ~PA-~1, November 1965 fl R
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