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STATB OF FLORIDA ~ ~
COUNTY OF ST. LUCIS _ ~
NbTICB is hereby given that pursuant to the provisions of
Chapter 65-2181, Lawa of Florida. Acts of 1965, the Board of County
Commissioners of St. Lucie County, Florida, claims a lien in the "
aluotlnt Of Si~Hun recl R4~rpnty-fi v~. anA 3~~„QA
625.35 ) Dollare against any real or persv~al property or ~
interest thereia presently hela-or after acquired by
. . _ ~ - - (Name of
Lew q., S.ikp~a Of
Indigent ot Recipient) (Ad resa)
for money directly apent by St. Lucie County for the care, hospital-
ization, sustenance or maintenance,of-eaid Indigent or Recipient ~ '
of welfare assistance, as fo2lows:
Hospital : Fort -Pierce Memor~,~,
- Date Admitt~yl: 6/2~7~~ - .
Date Discharged: 6~ry~~~ '
Number of Days s~,_ at $ ~~S _ n~ per day= $
, Less' credits None -
Amount of Li~en $ 625.35
DATED at Fort Pierce, Florida, this ~/p day of
Auqust . 191Z,,,• ~ _
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CLERK CIRCWt COUR P "
37s193 veA~F~E~~ ~ (si ature) -
AU6 Z3 Z 04 ~~~T County Attorney
(Title) ~
~ SWORN ta and subscri'bed before me '
this ~~day of , 29
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Notg=y Pub1fC State of FlOrida t` e>~~ w;~
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My Co~aission Expires s l-~ 7 ='`t~'~~'~{
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TNI$ INSTP.JA•~•.~ ~y~t4 PP.~?Ah~D DY - ' ,,,r~'~li.ia~~.~'~'~ ~ ~
RALPN 6. V'J!!.£J.`!. ~T. LU~i~ CC;Jt~lTY
COURj'HOUSE FT. P1cRGE. ~'LORIDA e * ~ _
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