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SZ'ATE OF FLORIDA a ~
FORM Fl-A. UC-1S DEPARTAIENT OF CO~I:IIERCE
(Itev, li/69) UIVISIOh OF LABOR ANU El?IYI.OYI?tENT OPPORTUNITIES ~8$~~8 j
~ ' ~ . TALLAHASSEE Account No. 039938
~ Lien No._ A-879
NOTICE OF TAX LIEN
Puisuant to the provisions of- Section 493.15 (3) (a). Florida Statutes. known as tl~e Floizda Un-
employment Compensation law, notice is fiereb~ given that thei•e have been assessed, pursuant to the
provisions of said 1aw, a~ainst J. Raymond Ortens T~A South Dixie Drive Inu .
P. 0. Box 1317~ Ft. Pierce, Flrorida 33450
an "employer" liable for the pa~~ment of contributions to the Unemployment Compensation Fund of
Florida~ pursuant to the pro~isions of said law~ the sum of $ 24_92 covei~ng the following ~ i
contributions, interest and penalties, which after demand for payment thei~eof remain unpaid~ .~nd
that by virtue of the above mentioned l~w the amount of said contributions (taxes), togetiier K•ith
penalties, interest, and costs that may acci~~e in a~idition thei~eto. constitute a lien in fa~or of State of
4 Florida Uepartment o! Commcrcc upon the title to and intei-est. whether legal or equit~ble. in any real
property, chattels real~ or pe~sanll property of said employer.
! Periods for which contributions, interest~ and pena)ties have been assessed, and the amounts
thereof, are as fo11oWs:
i ~
~
?EIt100 CONTRI6UTIONB ~NTEREST TMROUGM
?ENALTIE!
1 5 00
5 ~
~
s
' TOTAL ~ ~ 1 ~ yv W ~
WITNES3 THE OFFICIAL SEAL OF THE STATE OF FLORIDA DEPABTMENT OF COl?iDiEBCE
and the hand of t6e Director oi the Division of I.abor and Empioyment Opportunities thereof, at Tallahassee,
Florida. this~_tlsYvf _ 7]sn~b~?r , A. D. 19 (y9 ~f
r~ ' FILED AND RECOROEO ~ I
- ~ ,T. LUCIE COUNTY. FLA. ~
SEAL - - ~0~' `~~"~~~ED BTATE OF FIARIDFI _
' ' 1SS~OS DEPAR'iI~1T OF OOt~FtCE
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This iastrnmen~:~~isi'e~.%~= G ~
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',p;'_r~ `"~~TR~S ~~A Director of the Divis n of
Mary M. Harpei' C~ERK CIRCUIT COURT ~bor and loyment rtunities
Depirtment of Commeree BOOK ~u~ PAGE ~U ~7~
k; Csidwelt Bl~g., Tallahassee, Fla.
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