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NOTICE OF LIEN ,~~€A,c c+ r. ~~T ~pU~T
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STATE OF FLORIDA .
COUNTY OF ST. LUCI E 2~131
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Chapter 65-2181, Law~ of Florida, Acts of 1965, the Board of County
Commiss•ioners of St. Lucie County, Florida, claims a lien in the
amount of ~enty three hundred Eighty-one and 28/100
2381.28 ) Dollars against any real or personal property '
or interest therein presently field or after acquired by
rr~QQ~~~ ~ott~ ~f 706 N. 24th St., Ft. Pierce, Florida ~
(Indigent or Recipient) (Address)
.
f or money directly spent by St. Lucie County for -the care, hosp~ital-
ization, sustenance or maintenance of said Indignet ar Recipient
of welfare assistance, as follows:
Hospital: Fort Pierce_Memorial
Date Admitted- 3/29/74 ~
Date Discharged: 5/1/74
Ndmber of Days: 33 at $ 72.16 per day = $ 23g1.28
~ Less Credits None ~
~ Amount of Lien $ 2381.28
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Dated at Fort Pierce, Florida, this ~ y~ day of
July , 19 74.
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(Sign ure)
~ County Attorney
(Title)
~ S4,,'ORI~ to and subscribed before me _
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~ th i s~~ ~~day of _ . 19~•
~ _ ~ , .
~ Notary PLblic State of Florida at L rge •-'.~-~.,'.,t,: ,
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t•Iy Cor.vnission Expires : .
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THIS IN87RUMENT YVAS PREPAREO BY ~ `G`-,~•L:
~ RALPH B. WII.SON. ST. LUGE COUNTY , P U a V ~r;' '4 (0 PAGE V~
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CmURTHOUSE F7• P~ERCE. ELORIDA ' 2 . ~
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