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ST. IUCIE CO~Yr7l1M.
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NOTICE OF LIEN RE~~~~+K ~'~~~U1!•~OIIRT ~ - :
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STATE OF FLORIDA
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COUNTY OF ST. LUCIE ~
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Chapter 65-2181, Laws of Florida, Acts of 1965, the Board of County
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Commissioners of St, Lucie County, Florida, claims a lien in the
amount of ~o Hundred Sixteen and 48/100
2Z6.48 ) Dollars against any real or personal property ~
or interest therein presently held or after acquired by
ig~ivciYaa • ~ ~i ~411~ No- 25th St. , Fort Pierce, Florida~~
(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 follows: ;
;
;
Hospital- Fort Pierce Memorial
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Date Adm~_tted• 4/11/74
Date Discharged: 4/14/74_ ~
Number of Days: 3 at $ ~2•16 per day = $ 216.48
~ Less Credits None
E
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! Amount of Lien $ 216.48
Dated at Fort Pierce, Florida, this ~1 day of
July 19 74 -
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(Si ature)' '
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County Attorney ,
. (Title) `
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SWORN to and subscribed before me !
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~ this day of i . ZgL.._~ •
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: tvotary Public State of Flo_ id at Large~ ~~~1, i~
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~ :f, Commission Expires /'o~-,~ '~.,•;'%".~z" ,
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J~ THIg INSTRUMENT VYAS PREPAREO BY ~ ~~~1 ~r
~ RALPH B. WILSON. ST. LUGE COUNTY .'r•.; _
x GmUR7HOU6E. FTr P~ERGE. FLORiDA ~4: re,~"~; O R Q
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~ ~ BOQIf ~r~U PAGE 04~
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