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NOTICE OF LIEN ~4£~ ~~~~u~
RfCORC vfoi~ifD
~ Il 8 ~i ~'76
STATE 4F FL4RIDA
COUNTY OF ST. LUCIE 3S~~I~6
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 Sixteen and no/100
416.00 ) Dollars against any real or personal property or
interest therein presently held or after acquired by
(Easter Manor~ (Name of
Ruben Gibbs of 2705 Essex Dr.. Fort 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
of welfare assistance, as follows:
Hospital: Fort Pierce Memorial
Date Admitted: 7/23/76
Date Discharged: S/16/76
16 co-insurance days paid
Number of Days: at $ 26.00 per day= $ 416.00
Less credits None
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~ ' 416.00
I Amount of Lien $
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DATED at Fort Pierce, Florida, this /~i'' day of
December ~ , 19 76 , ~
. (Si nature)
~ ~ County Attorney
~ (Title)
SWORN to and subscribed before me ~
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~ this ~day of , l~
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Notary Public State of Florid af ~,ez~e
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~ ' My Commission Expires: /--2-/-;'/~;~,_
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