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NOTICE OF LIEN ~F ~ ~ ~
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~ ~ 8 58 ~'7~ '
STATE OF FLORIDA '
~8335 ~
COUNTY OF ST. LUCIE _ ~ ~~35 , ~
. . _ . ~ ~t--- - ,..,a- ~ti.e .,,-n.,;cinns of
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Chapter 65-2181, Laws af Florida, Acts of 1965, the Board of County
Commissioners of St. L~ucie County, Florida, claims a lien in the ~
amount of Five Hundred Seventy-seven and 28/100
577.28 ) Dollars against any r~a~or personal property ~
or interest therein presently held or.after acquired by
! • ~ s i4Al ~:rt~n.. A~ F~~~ D1 PYf!~, ~'~~Z'1C~4~
2(lt~.ll t'llllllY."/ V1 vva s+....••c:~ -
(Indigent or Recipient) (Address) - . ,
for money directly spent by St. Lucie County for the care, hospital-
ization, sustenance or maintenance of said Indignet or Recipierit -
of welfare assistance, as follows: - ~
~
_
Hospitalz Fort Pierce Memorial _ ~
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Date Admitted• 4/15/74 -
Date Discharged: 4/23/74
Number of Days: 8 at $ 72•16 per day = $ 5~~•28
F Less Credits - None
r
~ $ 5~~.2a
~ Amount of Lien
~
~ day of
Dated at Fort Pierce,-Florida, this
~ July , 19 74.
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(Sign ture)
:
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County Attorney ~
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(Title) ~
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S~40RN to and subscribzd before me
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~ this o~~}C.~-,day of . 19~5~-.
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• .
~ ~~i~Yt_- -
' j
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• t3otary Public State of lorida t Large
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riy Comrnission Expires: - _ 4 ~ : =
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THl~ IN3TRUMENT WA4 PREPARED SY ',~~i~••••~~~~~
~ RALPH B. WILSON. ST. LUCIE COUNTY .~~~i.`+rf ~ Ci~:t'~' ~
CmURTHOUbE. FT. PIERC£. FLORIDA ~ ~ gOOK~+t~Q PAGE S~
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