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NOTICE OF LIEN t
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STATE OF FLORIDA
~ COUNTY OF ST. LUCIE .
NOTICE is hereby given that pursuant to the provisions of
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 ~o aundred Seventy-four and 29/100
274.29 ) Dollar-s against any real or personal property or
interest therein presently held or after acquired by
(Name of
Fate Sims of 2313 S, 35th St., Ft.'Pierce, Florida
~ndigent or Recipient) (Address)
for money_directly spent by St. Lucie County for the care, hospital-
ization, sustenance or maintenance of said Indigent or Recipient
of welfare assistance, as follows:
I3ospital: Fort Pierce Memorial
Da te Ac3mi tted : 5/10/75
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Date Discharged: 5/13/75
Number of Days: 3 at $ 91.43 per day= $ 274.29 ~
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Less credits ~
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274.29 t
Amount of Lien $
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~ DATED at Fort Pierce, Florida, this day of
f
s
E September , 1975 .
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(S gnature)
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County ~?ttarney
~ (Title)
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S~~10RN to and subscribed before me
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this day of , 19~
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~ Notary Public State of Flori at•Larq.e`~~,~
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~ My Commission Expires : •
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THIS IN&TRUFtENT 4YA5 PR~PARED BY
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RALPH B. WILSON. 5T. !_UC:E GOUN"iY
COURTHOUSE, FT. PIERCE, FLOF2IDA ' '
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