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NOTICE OF LIEN
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8TATB 0!' FLt~tl~w
COUNTY OF ST. LUCIE
NOTICE i• hereby given that pusauant to the provision~ of
Chapter 65-2181. Laws of Florida, Acta of 1965, the Board o~ County
Coma?issioner: ~f St. ::~-j- -^_^unty, Florida, clai~as a lian in the
aawur~t of Eleven Hundred ~venty-t_ee anc! 80/100
1123.80 ) pollars against any real or personal praperty or
interest therein presently held or after acquired by
~ (Naw~ of
Jack Ransaa of 1217 Avenue D, Fort Pi~rce, Florida
Indigent or Recipient) (~?ddrmss)
for money directly spent by 5t. Lucie County for the care, bospital-
ization, eustenance or mainte~ance of said Indigent or Recipient
of welfare assistance, as followe: ~
Nospital: Fort Pierce l4ea?orial
_ Date Admitted.: 6/20/76
Date Discharged: 5/30/76 ,
Number of Days: 1Q at S 112.38 prr day= $ 1123.80
' Lesa creai Ls
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i Amount of Lien ; 1123.80
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~ DA'!~D at Fort Pierce, Florida, this ~ ~ _ day of
i
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~ October ~ 1 g 76 ,
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~OGER ~P~t1AAf
CcERr ;.•;;,~iT Ca~Mt (S gnature)
g R€CC~;t v~o~s~f0~...,.~~
~ ~1 u 3 SO ~~7i County Attorney
~ ~Title)
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~ SwORN to and eubscribe~ before nse
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~ this day of ~ , 19~.
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~ ' ~ . ; ' ,
~ I~otary Public Stat~ of Florida t Larp~"
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My Coarai~sian Expir~~: / - 7f
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RI~tLPH ~ Vri:. - 't _ . , . . . .TY • - . ~ ti'~
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