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NOTICE OF LIEN C~E~vEa1F,E0 C~RT .
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STATE OF FLORIDA
COUNTY OF ST. LUCIE
NOTICE is hereby given that pursuant to the provisio~s of
Chapter 65-2181, Laws of Florida, Acts of 1965, the Board of County
Commissioners of St. Lucie County, Florida, claims a lien in the
amount of One Hundred Thirtee~ and 62/100
4
113.62 ) Dollars against any real or personal property or ~
interest therein presently held or after acquired by
- (Name of
Charles Smith pf ~2704 Avenue Q, Fort Piecce, Florida
Indigent or Recipient) (Addressj
for money directly spent by St. Lucie County for the care, hospital-
,
ization, sustenance or maintenance of said Indigent or Recipient {
of welfare ~ssistance, as follows:
Hospital; Fort Pierce Memorial
Date Admitted: 2/13/71
Date Discharged: 2/15/71
Number of Days: 2 at $ 56.81 per day= $ 113.62
Less credits None
~ Amount of Lien $ 113.62 f
{ '
~
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~ DATED at Fort Pierce, Florida, this day of ~
~
~ MaY , 19 71. .
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- (S i nature)
County Attorney
(Title)
~ ;
~ SWORN to and subscribed before me
~
~
~ this ~ day of ~ , 19~.
~ l,~~'~;1.' ~ . ' : "
~ d ,~~~'~01~ R_ Y .
~ Notary Public State o Flori at Large -~1:' y~
~TM1 MItLIC, STATE OF RORIDA AT L~E ~ ~r?i~~ ;
~ 11y COMMISSION EXP1RES JAN. 21. 197~ P~~ ~"i y1~
My Commission Expires: ~ONO~u t~¢u FnFe w DtESt~i •
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THIS INiTRUMENT WAS PREPARfO [Y
RALPH B. WfLSON. ST. LIiCIE COi1NTY R ~~'Mtit+~~+'`~~
~ GOURTHOUbE. FT. P/ERGE, FLORiDA ~ ~
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