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~ _ STATE OF FLORIDA Z!~~ii'743
FDC FORM UCT~ ~e ~ DEPARTMENT OF COMMERCE
IREV. 7/73) _
pIVISIOIY OF EMPLOYNENT SECURITY
TALLAHASSEE 32304 Accou~t No. 185062
1VOTICE OF TAX I.IEN I-ien No. -
J E O P A R D Y
Pursuanc to the provisions o( Section 443.15 (i) (a), Florida Statuces, knuwn as thc Florida Un-
employment Compensatian law, notice is hereby given that there ha~e bccn asscsscd, pursuant co the
provisions of said law, against A1~CE H. Chavers T/A Al' S Coffee Shop
917 Avenue D ~
Ft. Pierce, Florida 33450
an "employer" liable fur the payment of contributions to thr Cncmplo~•mcnt Comp~•nsatiun Fund of
110.34
Flurida, pursuanc to. the procisions of said la~•, thc sum of S co~ering the folloaing
contributions, i~terese and penaltics, n~hich after ~lemand for pa}•ment thcreuf nmain unpaid, an~
that by virtuc of the abo~~e mentioncd IaH• the amount o( said rontributions ~taxest, to~echcr with
penalcies, ineere~t, and custs that may accrue in addition thereto, ronstitutr a licn in fa~-or of Siate of
F'iorid~ Deparlment ot f.ommerce upon the titlr to and interrst, ~•hrchrr leRal or cyu~tabic, in any real
~ property, chattels real, or personal properry of said employer.
~
I
Petiods for ahich contributions, interest, and penaities ha~•e bcen assc~scd, and che amounts
f thcreof. arc as folloas:
~
i
I
~ INTERESTTHROUGM
~ PERIOD CONTRIpUT10H5 3 31 75 PENALTtES
~ 3rd Quarter 1973 11 00 28 90 00
~ lst Quarter 1974 ~~Ea Rk: ~~EC~r~oEO (Bal) 9 Q6
~ T. R`~JCICr ' JiTR4S
i_~c i. .r,~1T COURT
Pfr ':~'rc =t:D~......~.~
~ 11 10 t4 A!!'1y
~ ~~~~03
~
~
~
~
~ TOTAL 11 OQ ZO 99 OV
~
~
~
s ~VITNESS THE OFFICIAL SEAL OF THE STATE OF FLORIDA DEPARTNENT OF CONifERCE
" and ih~~band ot lhe Di~c~ri~f the Division ot Employ~ment ~~uriiy~ thereof, at T~1lahassee. Florida,
~ this day ot P . A. D. 19
: ;
~i•r.
~ ' v ' ~ ~ " " STATE OF FLORtDA
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~ - - _ DEP:~RTMF~iT OF CON~tERCE •
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This inalrumeu~ prPpared b~~: •
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r SOQK~~t~ PAGE23~4 °"'E~ToR, D~V~S~ON oF
Drpartment o~ Commrrc~
CaldNell Bld~Cs. Tallrha~~PP. f ~71. E~1pL0`IMEMT SEGUitITY
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