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NOTICE OF LIEN ~IEFRC. ,~:J~TCGlMT
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STATE OF FLORIDA ~
COUNTY OF ST. LUCIE ~~~~s
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Chapter 65-2181, Laws of Florida, Acts of 1965, tbe Board of County
Commissioners of St. Lucie County, Florida, claims a lien in the
amount of Seven Hundred Twenty-one and 60/100
721.60 ) Dollars against any real or personal property ~
or interest the~ein presently held or after acquired by
- -s _ u ~ ~t _ _ ~~±rt pi ~~c~, Florida
wasn r~un~Y ~i - • -
` ` ~(Indigent or Recipient) (Address)
f or 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: 4/9/74
- Date Discharged: 4/19/74
Number of Days: 10 at $ ~2•16 per day = $ 721.60
~ Less Credits None
{
~ $ 721.60
~ Amount of Lien
~
Dated at Fort Pierce, Florida, this ~ day of
July , 19 74.
.
" (Sign ture) •
County Attorney
(Title)
k~ ~
SWORN to and subscribed before me
~ .
th i s~~~i day of • 19~ -
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j`Y~-/ ' ,~~~~1.~,:,~,r~i-, ~
~ NoLary PUblic State of Florid ~ at Larg~~`~e ~ ~
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Ex i r es ~ ' ~ : fa~ ~ ? .G;' ~
My Co~rsnission p / - = -
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THts INSfRUMENT 1WA9 PREPARED DY ~~i C,: • ~i
RALPH B. WILSON. ST. LUCIE COUfVTY ~~~~ii~~~„~ BO~K~O PAGE V~~
COURTHOU6~ FT. PlERCE. FLORIDA - ji~+r~'
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