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STATE OF FLOR,IDA •
FDC Form UCT,18 DBPARTMENT OF COMMERCE .~3~SS~
(Rev. 12/70) DIViSION OF LABOR AND EMPLOY~iENT OPPORTUNITIEB
TALLAHASSEE Accouht No. l TT~7
Lkn No.~_ ~ s s
NOTICE OF TAX LIEN
Pui•suant to the provi.~iona oi Section 443.15 (g) (a)~ Florida Statutes. known aa the Fto~•Iciu LIn-
employment Compensxtion law, notice ia hereby given that there have been asaesseci. purauunt ta the
pibvieione of a~id law. a~tainat_ Timothy Davis T/A Timothy Davis Buildin~
Construction Company
2807 Avenue "H"
Ft. Pierce, Florida 33450
an "employer" lial~le for the puyment of contributionR to tl~e Unemployment Compenution b'und ot
Floi•i~is. pureunnt to the protiisions of said law, the sum of ; coveiinR the folbwin~
contributiuna. intereat and penalties, which aiter demand for payment thereof rem~in un{wi~~ ~nd
that by virtue of the alwve mentioned law the amount of said contributiona (t~uces). to~ether v?~ith
penalties. interest. an~ coata that tnsy accrue in addition thereto~~conatitute ~ lien in fi?vor of St~te et
Florida Uepsrtment ot Commerec upon the titie to and inte~~eat~ whether IeR~tl ar equltttbk. in any re~!
property. chattele real~ ue• pe~~onal property of anid employer. _
Perioda for which contributiong, inierent, and penAltiea hAVe been assesaed, and the xmuunts
thereof. Are aa iollow s:
~~ioo ea+T~i.u*ioa• 7- 1-72 ~~«u~
3i'i'1 ~I:lat yi.c2' i3~~ ~ R°~.. l Z ,?C~ ~ 1 ~?~j ~l~
i ~+th uarter 1 0 1 8
I
~
!
~
i
~
E
; -
~
i
~
! TOTAL 1 Z 6 4 ~
~ W1TNE88 THE OFFICIAL SEAL OF THE STATE OF FLOBIDA DEPARTMENT OF COMM~RCE
~ snd the hand oi the Di~eetnr of the Division of I.abor ~nd Employment Opportunitie~ thereot. ~t TaUah~Nee.
Florida, thi~~_day oi August . A. D. 19 72
i
~ fitEO a~= ~~~3~OE0
€ St.IUCIF ~~~~Hjl FIA.
f aG;,~ c.;a~?s ~ STATE OF FLOR[DA
? SF~L • CtE~K •~,L'S CO~RT DEPARTMENT OF COMMERCE
k Rf~~q.~ ti~~ ,tp
~ - ~ 8 Il 2o eN'~~ Z
= Thi~ matrurnent prepared by:
6
~ ~ i.[~nn 1+' _ WeSVer JP . ~v~VVJ
~ OIRCCTOR, DIYIi~ON 0/
ikpartment ot Commeree L~~y~~ LA~OR ANC [M~LO~M[NT O/'011TUNITIl~
~ Cal~lwell F31dR.. Tallsha~see. Flt. op~~r ;~~ji
j p~~
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