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NOTICE OF LIEN CtfRKt;~;,,~it~,*,,,~,,,
. 11FCOR~~ V(.' v~
QEC Il 9 3i '7b
STATE OF FLORIDA
352699
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 Four Hundred Forty-nine and 52/100
449.52 ) Dollars against any real or personal property or
interest therein presently held or after acquired by
(Name of
Carolina Washington og 514 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 Indigent or Recipient
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vi wCiic?ic Fa~~ia..c~.'.~~• ~:j 1V11VOJ:
Hospital: Fort Pierce Memorial
Date Admitted: 8/16/76
Date Discharged: 8/20/76
Number of Days: 4 at $ 112.38 per day= $ 449.52
! Less credits none
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~ ~ Amount of Lien $ 449.52
i ~
~ DATED at Fort Pierce, Florida, this ~L day of
December' , 1~6 .
~r
(Si nature)
~ County Attorney
~ (Title)
~
~
~
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; SWORN to and subscribed before me
~ .
this ~ day of ~„GGG~ _ , 19~,"` • .
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Notary Public State of Florida a Laicge~ ~
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; My Commission Expires : /-1/- T ~ t~'
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THIS INSTr!UM~••' ~VAS AP.C?ARED CY ~ ~i_ /1AI - - - nC^
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