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IN THE CIRCUIT COURT IN AND FOR ~
ST. LUCIE COUNTY, FLORIDA
CIVIL ACTION NO.: 75 286 CA
HELEN OLINGER, as Administratrix
of the Estate of Lee David Olinger. -
deceased,
~laintiff,
vs. -
WINN-DIXIE STORES, INC., a Florida
corporation, ROBERT LEE BRAXTON & .
FIDELITY & CASUALTY COMPANY OF
NEW YORR, a Foreign corporation,
~ointly and severally,
Defendants.
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NOTICS OF PAYI~NT OF CO1~Il'ENSATION AND MEDICAL _
BENEFITS AND CI:AIM OF LIEN Z~FOI~
The Travelers Insurance Company, Workmen's Compensation
insurance carrie= for Velsico Chemical Corporation, by and
through its undersigned attorneys, hereby asserts its lien, _
pursuant to Section 440. 39 (3) (a)_, .F~orida Statutea, for. compensa- -
~tion and ~edical`benefits heretofore paid and hereafter-to be ~
paid to or on behalf of the above-captioned Plaintiff, Helen
Olinger, as Administratrix of the Estate of Lee David Olinger,
deceased, by reason of the injuries sustained bq the said
Plaintiff in the~accident which forms the sub3ect matter of
i this cause as is more particularlq described in the Complaint
i '
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~ filed herein, which said incident arose out of and occuned
~ within the course and scope of said Plaintiff's husband's employ-
~ ment for the a~foresaid Velsico Chemical Corporation.
The Travelers Insurance Company accordingly prays that
this Notice be considered by the Court to be a lien against
~ any judgment or settlement entered in this cause as provided
~ ~ by Section 440.39, Florida Statutes.
~ The Clerk of the above-captioned Court is further requested
~ .
~ .
~ to file this Notice in the Court file of the above-captioned cause
~ and to record a copy of same in official records.
~
I HEREBY CERTIFY that a copy of the foregoing~has been
:
BOOK 243 PACE 2~~
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