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C L A I M O F L I E N
(Chapter 59-984, Laws of Florida)
STATE OF FLORIDA
COUNTY OF ST. LUCIE
Before me, the undersigned authority, personally ap-
peared NORM~IN L. PAXTON, JR., who beinq duly sworn says that
he is the attorney for the Lienor herein, FORT PIERCE MEMORIAL
HOSPITAL, INC., whose address is 707 North Seventh Street, Ft.
Pierce, Florida, and that the Lienor has furnished hospital care,
treatment and maintenance to ORETA DEESE, whose address is 1404
Boston Avenue, Ft. Pierce, Florida, for the period from September
13, 1975 to October 18, 1975 of a total value of Three Thousand
~tao Hundred Sixty-two and 35/100 ($3,262.35) Dollars, of which
the sum of T~iree Thousand ~ao Hundred Sixty-two and 35/100 ($3,262.35)
Dollars remains unpaid, for which amount the Hospital claims a
lien upon any cause of action suit, judgment or settlement that
said ORETA DEESE may have on account of injuries which necessitated
such hospital care, treatm~ent ~ancY'maintenance.
~ The persor?s claimed by said ORETA DEESE to be liable on
t account of such injuries are: ALLAN H. CLAYTON; B.B. ROSIER, d/b/a
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~ FT. PIERCE CAB CO. and CANAL INSURA.~ICE COMPRNY, c/o George S. Okell,
~ Jr., 509 North Dixie Highway, West Palm Beach, Florida, 33401.
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FORT PIERCE MEMORIAL HOSPI , INC.
,
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BY :
Norman L.~Paxton, Jr., Atto
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worn to and subscribed before me this ~ day o
, 1977.
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sj aoCE~ P4~t*~; ~ State of Florida, at large 7
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TH~S INSTRUMENT ?FEpARED BY _ • ~ ~ ~ ` ' ~ '
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