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STATB OF FLORIDA
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NOTZCS is hereby given that pursuant to the proviefons of
Chapter 65-2181, Lawa cf Florida, Acts of 1965, the Boarc~~of County
Commisaioners of St. Lucie County. Florida, claime a lien in the
amount of Seven Hundred Fifty a~d 42/100
750.42 ) Dollare against any real or peraonal'property or ~
interest t2~erein presently held or after acquired by
, . (Name of
Simpson Jones pf 602 Means Court, Fort Pierce, Florida
Indigent or- Recipient) (Address)
for money directly spent by St. Lucie County for the care, hospital- ~
ization, eustenance or iaaintenance of said Indigent or Recipient '
of welfare assistance, as follows: -
~ 8ospital: Fort Pierce Memorial
_ Date Achnitted: 5/7/77
Date Discharged: 5/13/77 ~ -
Number -of Days: 6 at $ 125~.07 per day= $ 750.42
Less credits None
Amount of Lien $ 750.42
DATED at Fort Pierce, Florida, this ~ 3 day of
~ June , 19
~ 3~a3o4 .
iT.ltiC1E COY1~
f U?. (Si ature) ~ ,
ItOCER PO TRA County Attprney
CLERR CIRCWT COU
PF~nR? YERIFiEO (Title)
,1u~ t~ i l Zi AM'T1 ~ _
SWORN to and subscribed before me ~
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th i s ~.~ii,C_ da y of ~ , 19~? . ~
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; Notary Public State of Flori a at~i;~rge` -
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