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. STATE OF FlARIDA 3~~~8 G-
RDC QOQM UCT.~. DEPARTMEMT OF.COMMF•itCE
IR[V. t2H{l . . .
DIVlSIOIY OF EMPIAYMENT SBCURITY -
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TALLANASSEE 3Z304 p~p~ Na 337069
r~^ N4TICE OF TAX I:iEN no. 6-14125
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Pursua~t to the provisio~s oi Sectioo 443.15 (3) (a). Florida Statutes, known as the Flo~ida Un• . '
employment Compensation la~v~ ~otice is heredy given thae the~e have been assessed, pursuaet to the
-provisions of said laa, against A1toA S. Be881eY a-
P. 6. Box 1208 - .
~ Ft. Pieroe, Florida 33450
an "employe~" liable for the paym~nt of. contributions co' che Cnemploymenc Compensation Fund of
Florida, pursuant to the provisions~ of said law, che sum of $ 157 _ 16 - coveFing the follow in$ _
coatributions, intetest and penalties; which after Jemand for payment tficreuf r~main unpaid, and
that by virtue of the above mencioned la~?r the amount of said concributions:(taxes-), together aith
pe~alties, interest, and coscs that may arcrue ~in addition thcrew, consc~i~tr a°tiea~in favor of State ot
Florida Departmeat ot Co~nmeree upon thc citl~ io and in~eiesc, ahrchcr ~icga) ~r cquic~tbl~, in any real -
property; chattels real, or personal praperty of said employer. -
Periods for a?hich concr'tbucions, incerest, and- penalties ha~e been assessed* _and che amouncs
theteof, are as follows: _ • _
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~ QUARTEA15) INTEREST TNROUGM , ~ - - _
QTR. YEAR TA7IE5 T S 1
E 3 76 ~ 156 ~ 38 76 ~ c~~~ .
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SERVICE FEE
TOTAL . ~.SG 38 76 ~ _ §
~VITNF..SS TYB OFftCiAL SEAL OF THE STATE OF FLARIDA DBPARTMENT OF COMMERCE
~1 tbe ~ot tbe Dinrto~ o! tbe Divislon ot Employmeot Seenrli~ t6ereof. at Tallal~assee. Fbrida. -
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~r~i~- , A. D. 19 7C n,
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~~`.~r?.;~-~`'~ l. F=~ : - STATE bF FtARIDA
- ~ ~ ~~'~~'"~,.•t°', DEPARTME:VT OF COMMERCE
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r • A. J. MoMUll1AN 11)
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'~emm~rre ~ DIRLC7~OR, O1VIS~ON OF
Caldrell 81d~.. Taltaba~xte. Fla. - SFC1JRtIY -