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Naric$ oF LzEN
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STATS OF FLORIDA ' •
cc~uN~rY OF ST. LUCiE ~
NOTIC$ is hereby qfven that pursuant to the provieione of
Chapter 65-2181, Lawe of Florida, Acts of 1965, the Board of County
Commissioners of St. Lucie County, Florida, claims a lien in the
amount of Thirteen 8undred Forty-eight and 56/100
1348.56 g y perBOnal property or
) Dollars a ainst an real or
interest therein presently held or aftei acquired by
Willie Scriven of 1239 Avenue D, Fort Piierce,f Florida
Indigent or Recipfent) . (Addresa)
for money directly spent by St. Lucie County for the care, hospita2-
ization, sustenance cr aaaintenance of.said indigent or Recipient ~
of welfare assistance, as followss
Hospital: Fort-Pierce Memorial
Date Admitted: 3/11/77
Date Discharged: 3/23/77 -
Number of Days: 12 at $ 112.38 per day= $ 1348.56
Leas credits None ~
Amount of Lien $ 1348.56 ~
~DATED at Fort Pierce, Florida, this ,Z3 day of ~
June , 19 77 . .
S • ~E COII~Rt?~~~ i,
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oaEa ron~~t ~
CLERK CIRCUiY 00 ~ (S gnature)
!'F~A~f~ yERIFIED ~
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23 ~~11 Countv Attornev
3r10311 " (Title)
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SWORN to and subscribed before me - .
this ~jit~(- day of ~ ~9? !
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Notary Public State of Florida t y~~ge E
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My Commission Expires: ~ -z/- ~r'~~' ~
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THIS INBTRUl.tE?JT VVAB PR£PAREO ~Y . -
RALPH B. WItS0~1. ST. LIiC{.~. C'JUN7Y '
COUR7HOU5E. F7', p1ERGE, pLOR1DA