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NOTICE OF LIEN C~ERK fl :Gylts;Q~ ' - ,
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STATE OF FLORIDA ~ ~,~y
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COUNTY OF ST. LUCIE 2~1~+`
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•Chapter 65-2181, Laws of Florida, Acts of 1965, the Board of County
Commissioners of St. Lucie County, Florida, claims a lien in the
amount of Eighteen Hundred Four and ~0/100
1804.00 ) Dollars against any real or personal property '
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or interest therein presently held or after acquired by
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Wllll@ ti08LVi1 vt -s.+v a~~. • - - - ,
(Indigent or Recipient) _ (Address) • ~
for money directly spent by St. Lucie County for the care, hospital-
ization, sustenance or maintenance of said Indignet or Recipient
of welfare assistance, as follaws: .
Hospital: Fort Pierce Memorial
Date Admitted: 4/12/74
Date Discharged: 5/7~~4
Number of Days: 25 at $ 72.16 per day = $ 1~804.00
! Less Credits None .
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t Amount of Lien $ 1804.00 ~
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Dated at Fort Pierce, Florida, this ~ 7~ day of #
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~ July , 19 74 ;
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(Sign ture)
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County Attorney k
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SWORN to and subscribed before me
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~ this ~ day of , 19~
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(/1C/~C..GC~~ ~ i ~ ` y L. .
~ Notary Publi 8tate of Florid~ at L rge " '~G
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My Co~nmission Expires:~_~~~,Z,~ c•`'
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' TH~s INSTRUMENT 1NA$ PREPARED sY ~r` ' • . . • f
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~ RALPH B. WlLSON. ST. LUCIE COUNTY ~ PAGE VW
COURTHOUSE. FT. PIERCE. FLORIDA . - gQOK~rVV
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