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NOTICE OF LIEN ~~aK ~'~kCWt CouRT
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STATE OF FLORIDA
2959'79 '
COUNTY OF ST. LUCIE - '
NO"tIGE is h~re3~y given t2~~t pursuant to the grgv~~iQns Qf !
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 Seven Aundred Twenty-one and 60/100
721.60 ) Dollars against any real or personal property ~
or interest therein preaently held~or after aequired by .
Henrv Shink - Qf 418 N. lOth St.-, Ft. 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 Admitted: ~/19/~4 `
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Date Discharged: ~/29/74 _ ~
_ . 721.60 ~
:Number of Days: 10 at $ 72.16 per day $ 4
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. . . Less Credits None
Amount ~of Lien $ .721:60 ~
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Dated at Fort Pierce, Florida, this Z'~ ~ day of ~
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November ~.lg 7~ - :
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_ (Sign ure) _
County Attorney ;
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' (Title) !
2
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~ SWORN to and subscribed before me
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this ~ ~ day of r~~~~~ , 19_~S~ . : _ ~ .
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Notary Public State of Florida t Larg~~.,~ r~;
• ~ / - y/ - 7~ : ~ ~
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My Commission Expires . _ : . : !1 ~ ~
Nor~~,r Pue~ic st~?te or~c4t~t!~'~i C•: ' ~
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?tr coMM~rt~,~ cxr:~' .ytP ~ ~s: :
EONDfO ~HRU GfNERAL INSUR/1~.:' : ~
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THIS I~J9TRUME~;T ~lAS PRFP/' 'ED E3Y ~~:t~~••.'
RALPH B. W{LSON. 5T. LUC'-. :'~LI`lYY
COUF2THOUSE, FT. PIERGE, FLOR(DA - g~~~ Q~ 15
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