HomeMy WebLinkAbout1783 ~ ~{ICl ~ R~ ~
~ ~ OQER POITI~ ~
~ CtEIlK C+RCUIT CO~p~T
I1~CORD vER~F1E0
SATISl~,1C'PI~t~ O1~' ]i0 ~T'IT~1L~ ~,ZT~,1~ ~ ~ ' ~~Z
KN OlJ ALL MEN BY T1~Sr PI~LSIst1TS : • 2~5~
That GOOD SArL'1RI'rAN IiOSPITAL ASSOCIATION, OP~RATING T~iL: GOOD
Sl1~1ARITAN HOSPITAL, ldes t Palm Beach, Florida, thQ ownor und holdor of
a certuin LiQn for ;Lhc~. ilarnishin~ of hospital sQrvices to -
EI~WIN L. CANADAY
,~s a patient in said hospital, has
roceived i1i11 payment of the sums to which it became entitled by
virtue thereof, ~nd for and in considaration of the sum of ~~F
TIiOU SAND FI VE Hi1NDRED THIR'i'Y EIaHT DOLLARS & 3, 538
- gnRm~x r.~Nm~ ) DOLLARS,
does hereby aclrnowled~e full payment and complete satisfaction of said
Lien, notice of which was duly e~:ecuted and recorded in the public
records of Palm IIeach County, Florida, on the 13th dag of
JIINE , 19 in Official Record Boo~t 203 , Page
815 , and the said Good Samaritan Hospital Association,
Operating the Good Samaritan Hospital, does hereby flilly release and
discharge the aforesaid patient from the operation and effect of said
Lien Claim, and the Clerk of tYie Circuit Court of Palm Beach County,
Florida, is hereby directed to satisfy and cancel said Lien.
IN WITiIESS jlI~R~CF, the said GOOD SAt~iARITAI~T HOSPITAL ASSOCIA-
~ TIOIJ, OPERATI2IG TH~ GOOD SAI~SARITAN HOSPITAL, ~•~est Palm Beach, Florida,
has caused these presents to be signed in its name by its Billin~
Supervisor and witnessed by the undersigned.
, GOOD SAi~GARITAN HOSPITAL ASSOCIATION
OPERA HE GOOD S•'IAR AN HOSPIi1~L
By ~ G ~
(Mrs.) Pearl A. Long
VJit ',ss: Billing 3upervisor
~ ^ ~ ~ << <c~' ~Z~,
~ ;
~ ~---{Mrs. ) Helen M. Shearston
Billing Clerk
~ Subscrib~d and sworn to ~
be; ore mQ tlii s 11tYDa f
of September 1972 . ~ -
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~ Wot;c~ry t ic ~ .NCi!~
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NOTARI~ M1QUG St111f Of FLORIDA lIT UIR6E ~
: -.rv ~ ~ ~ ~ ~ .
MY COMMISSION EXPIRES MAR. 5, 1974
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