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~ NOTICE OF LIEN A~~p~D YER~?
ED ~W~
D~c 3 d w AN'11
S TATE OF FLORI DA
CORJNTY OF ST. LUCIE
NOTICE is hereby given that pursuant to the provisions of
Chapter 65-2181, Laws of Florida, Acts of 1965, the Board of County
Conm~issioners ci St. Lucie County, Florida, claims a lien in the
Seven Hundred Ninet five ~nd 34/100 ~
amount of y-
795.34 ) Dollars against any real or personal property or
interest therein presently held or after acquired by
{Name of
Annie Mae Tate pf 1610 N. 14th St., Fort pierce, Flcrida
Indigent or Recipient) (Address)
for money directly spent by St. Lucie County for the care, hospital-
ization, sustenance or maintenance of said Indigent or Recipient
of welfare assistance, as follows:
Hospital• Fort Pierce Memorial
~ Date Admitted: ~/10/71
i
~
~ Date Discharged: ~~24~~Z
~
; Number of Days: 14 at $ 56.81 per day= $ ~95.34
¢
,
Less credits None
;E
~ Amount of Lien $ 795.34
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~
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~ DATED at Fort Pierce, Florida, this ,Z/Nt~ day of
~
~ December ~ lg 71. `
. ;
~ S
i
:~S 1
~ ~
~ j
(S gnature)
- County Attorney
~ (Title)
~ SWORN to and subscrired before me
this ~/k~ day of ~ , 19 7/ . -
. ~ . t
:
L`~ Notary Public State of F1 da at Large _ '
_ _ :
= My Commisaion Expires: ~ -
4
L.':'
THIS INS'rR;;N,F^.T \ti-AS PR£?ARED PY - . ~'~•'b`.~ :
~ ~ _ ;y~~.I .
~ RALPH B YVILSG~i. ST ! ~~C!c=. GOivNTY - .
COURTFlOI:SE, FT. PIERGE. FLORi • , ,
~~~7 ~~96~ -
_