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NOTICE OF LIFN c~EaK c~ ~~~T CauRT ~
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3TATE OF FLORIDA ~
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COUNTY OF ST. LUCIE
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Chapter 65-2181, Laws of Florida, Acts of 196~, the Board of County
~ommissioners of St. Lucie County, Florida, claims a lien in the
amount of Eleven Hundred Fifty-four and 56/100
1154.56 ) Dollars against any real or personal property " !
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or interest therein presently held or after acquired by
~.~~R~ t1Q~ N. 17th St., Ft. Pierce, Florida E
tlivula.'7 Laa uaaova vi - - - -
(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 ass'istance, as follows:
Hospital- Fort Pierce~Memorial
Date Admitted: 4/28/74
Date Discharged: 5/14/74
I Number of Days: 16 at $ 72.16 per day = $ 1154.56
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~ Less Credits None
~ - $ 1154. 56
Rmount of Lien
Dated at Fort Pierce, Florida, this _~i day of
July , lg 74 - -
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(Sionature) ~
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County Attorney f
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SWORN to and subscribed before me
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~ this ~_L^_day of ~ , 19~
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Notar}• Public State of Florida at arge •',-~;~;~,~;j;;,• '
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" *1y Comrr:ission Expires: a~'/-~y • ~
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THIS tNSTRUMENT WA3 PREPARED DY ~
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RALPH B. WILSON. ST. LUCIE COUNTY 7f~•. ~.;•'~`tix~
COURTHOUSE. FT. PIE.RCE. FLORiDA . 'r O R j~ PAGE Q~Q
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