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IN THE CIRCUIT COURT 1VINETEENTH
JUDICIAL CIRCUIT IN AND FOR SAINT
LUCIE COUNTY, STATE OF FLORIDA.
NO. 69-700
FRANK MARTIN,
Plaintiff,
-vs-
DENNIS BUCKLEY, SR. , and YOSEMITE
INSURANCE COMPANY OF SAN FRANCISCO,
CALIFORNIA,
Defendants.
NOTICE OF LIEN FOR PAYMENT OF COMPENSATION
AND MEDICAL BENEFITS
HARTFORD ACCIDENT AND INDEMNITY COMPANY, the workmen's
compensation carrier for the employer of the plaintiff, FRANK MARTII~T, by
its undersigned attorneys, pursuant to §440. 39, FLA. STAT. , gives notice
that FRANK MARTIN was in the course of his employment with the employer.
Tropigas Inc. of Florida, when he was injured at the time and place alleged in
the complaint filed herein and that said workmen's compensation carrier. .
Hartford Accident and Indemnity Company, has through October 30, 1969,
,
~ paid to the plaintiff FRANK MARTIN, the sum of $184. 50 for workmen's com-
~ pensation and medical benefits, and said workmen's compensation carrier
~
~ gives further notice herein that it is possible that future compensation benefits,
~
~ '
medical benefits and other benefits under the Florida Workmen's Compensation
~ Act will be paid to the plaintiff.
~ WHEREFORE Hartford Accident and Indemnit Compan , by and
~ , Y Y
~ through its undersigned attorneys, prays that this notice will be recorded
~
~ and the same constitute a lien on any recovery by the plaintiff for the full
~
amount of benefits previously paid to the plaintiff under the Florida Workmen's
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