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STATE OF FLORIDA
FDC FORM UGT-ls DEPARTMENT OF COMMER~E ~2154
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UIVISION OF EMPLOYMENT SECUR[TY
TALLAHASSEE 32304 Account No. i 21~~2
NOTICE OF TAX LIEN Ljen No. q?
J E 0 P A R D Y
Pursuant to the provisions of Section ~i43.15 (3) (a), Florida Statuces, known as the Florida Un-
employment Compensation law~ notice is hereby given that there have been assessed, pursuan~ to the
provisions of said law, againsc Ole Colony Restaurant, Inc (A Florida Corporation)
1812 South ~+th Street
Ft. Pierce Florida 3345Q `
an "employer" liabte for the payment of contributions to~ the Unemploymenc Compensation Fund of
Florida, pursuant co che provisions of said law, the sum of = ~n6 _~n covering the following
contributions, interest and penalties, which after demand for payment thereof remain unpaid, and
that by virtue of the above mentioned law the amount of said contributions (taxes), together with
penalties, interest, and costs that may accrue in addition thereto, constitute a lien in favor of State oi
Florida Departmeat oi Commerceupon the title to and interest, whether legal or equitable, in any rcal
property, chactels real, or personal property of said employer.
Periods for ~rhich contributions, interest, and penalties have been assessed, and the amouncs
thereof, are as follows:
i INTEREST THROUGH
pER~pp CONTRIBUTIONS PENAlT1E5
4th Quarter 197 5 00
lst Quarter 197 72 00 4 32- 65 00
2nd Quarter 197 9~+5 43 5~ 00
TOTAL $1 k ZZO OO
~VITNESS THE OFFICIAL SEAL O~' THE STATE OF FLORIDA DEPARTMENT OF COMMERCE
and ihe Land ot t6e Director of the Division of Employmeni Security thereot. at Tallahassee. Florida,
- May . A. D. 19 7~+
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! ` ~~~{kIE 40YMTY DEPARTMENT OF COMMERCE .
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` CIERK 4sRCMNZ COUIIT
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Department of Commerce OIRECTOR, o~v~sioN oF
EMPLOVMENTSECURITY
Caldwell Bldg., Tdlahassee, Fla.
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