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NOTICE OF LIEN C~E~R L: ~UiT CCURT 0
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STATE OF FLORIDA ~ 30 ~ S? NN !r~
2881 ~~30
COUNTY OF ST. LUCIE ~O
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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 Bixteen Hundred Fifty-nine and 68/100
1659.68 ) Dollars against any real or personal property '
or interest therein presently held or after acquired by k
~a~~i~ Sa1~mQn 1717 Avenue L, Fort Pierce, Florida ;
-
(Indigent or Recipient) (Address)
t
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 follows:
Hospital: Fort Pierce Memorial
Date Admitted: 4/10/74 _
5/3/74
Date Discharged:
' Number of Days: 23 at $ 72•16 per day = $ 1659.68
~
i
! None
~ Less Credits
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~ $ 1659.68
~ - Rmount of Lien
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Dated at Fort Pierce, Florida, this ,1i~ ~ day of
July , 19 74. ~
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_ • i
(Sign ture) ~ ~
,
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County Attorney
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(Title) ~ ;
. ;
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~ Sw'ORN to and subscribed before m°
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t};; S ~ ~ay of . 19~
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. , .
/ ~/~Ri/V~ • ;l.lll~~~~J-' . . '
_ Notary Pu lic State of F~orida a Large 2'=j
. 1i ~
My Commission Expires : . ; : r~ • ' • - •
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T THIS INSTRUMENT WAS PREPARED OY • ~i~' ~h~ ~r~x~C, * Q
RALPH B. WILSON. SL LU~IE COUNTY , •-~,,,j~,~~~~~.,;;~.~~ ~pQK~O PAGE V~~
,LOURTHOUSE, FT. PIERCE. FLORIDA ' .
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