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2F.?!G~/1 I fILEO AN~ RECOROEO G
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CIERK CF,~F EO COU`~
NOTICE OF LIEN RECORO ~E
~ ~3 10 ia AI~'7Z
22201'7
STATE OF FLORIDA
COUNTY 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
i
Commissioners of St. Lucie County, Florida, claims a lien in the
amount of Six Hundred Eighty-one and 72/100 -
681.72 ) Dollars against any real or personal property or
interest therein ~l~$Gliiil~ held or after acquired by
(Name of
Roosevelt Coleman nf 610 N. 14th St., Ft. Pierce, Florida
Indigent or Recipient) (Address) ~
~
for money directly spent by St. Lucie County for the care, hospital- fi
t
;
ization, sustenance or maintenance of said Indigent or Recipient
of welfare assistance, as follows:
i
Hospital: Fort Pierce Memorial ~
i Date Admitted: 10/18/71
€
` Date Discharged: 10/30/71
~
~ Number of Days: 12 at $ 56.81 per day= $ 681.72
~
€
Less credits None
~ Amount of Lien $ 681.72
~ .
a
~ DATED at Fort Pierce, Florida, this /Q? ~ day of ~
3~
~ January ~ 19 72.
~
•
1 (S gnature)
~ County Attorney
_ (Title)
K;, SwORN to and subscribed before me
_ ~
this 2~ day of ) rLU..~2~ . 19~. .
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Notary Public State of ~`lorida Large - ~ ~ - L
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= My Commission Expires : .s' . -
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THIS INYTRU/AENT WAS PREPA/iE0 OY ' i .
" RALPH B. WILSO~d. Sl'. LUCiE Ct~UNTY
: GOURTNOU6~ ~~~G~~~~~~"~q~
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