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USE ONLY AS THE LAST RESORT lN COLLECTION
EFFORT! ~
STA?E OF FLORIDA
F~k affer regular colkction e(torts have been compkted and at •
least !80 days of indebtedness have accrued. COUN'I'Y OF
If indebtedness continues to accrue after original lien is fikd. fih
an additional "Votice of Lien" for every_180 days ut indebted-
nta incurrcd. . Clerk oi the Ci 't Court in and for the county afortsaid, do
hereby certity that the above and [ore~oing copy of "Notia of ~
File "Notice of Lien" in county of residence of client or rcsponsi- Lien" was filed
h!r party Liens can also be tikd ~n any other counry if asxts arc
known to exist or are presumed to exist in those counties. for record in my oftice on the
List and include the cost of "Filing Fees" when biiling the client ~ i~~/ry
~,r responsibk patty. Procedute: ~~y pf ~1 ~ Iq / d
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1. List Ci~ent Number ot Socia! Security Number. at M.. and.w uly recorded
2. List Lien Number. Use district designation and consecutive .
numbers. (Example District IV would ux 4-1, 4-2, 4-3, etc.) ~ ~ 8ook No.~.~
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3. List Name and Address of Client or responsibk party lien is
tiled a~ainst. at pa~e 9G~ in thisotfia.
4. Fint lien may be fikd after tees have accrucd for at least
~ 180 days ~rom Much 1. l977 and the client or responsibk puty 0~t~e ueo[ I have heteunto set my hand and the seal oi "
has been properly billed. Fill in total amount ot unpaid fees \4. ~.~y ~=y and year last above written.
listing month, yrar and fee assessed. Use separate line for each V.:
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prriod covered. Include cost of Filing Fea (Note: Most Ckrks of ; <<~'t ~
the Circuit Courts require payment in advance for filins the ' j~'' .
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"Notice of L~en". Cost of filing documents are luted in Florida ;
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Statutes - Chapter 28.) • .
•r., ~ rk o e Circuit Court ' and
S. Enter datt ptepared. ~'i:''. q; . .
fot asid County and State
~ 6. Person preparing form should sign including -tide and ~~~~~~-~y f~~ED ~N0 RECOROE~
address. ~?t~,~~;,,a.
l ST.I,UCIE COUMTr f~A.
~ P.OCER POITRAS
DISTRIBIIiION:
S:? F"r,K f,~R ~~;IT CCI!
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Onginal (white mailyd oc d4livercd to Clqrk.ot Cucuit'Cc~urt ~n By
~ounty filed. Any number oE documents ran~be mai~ed~togcther. 114P ~n /Z•[~~ O
Include fee (or each document. t~ T~T
Canary rolored copy delivered personally to "Ciient" or sent by
mail to the "Responsibk Party". - 7
Pink colorcd copy retained in originiting office for futurc rcfer-
cnce. ~ -
~:oldenrod copy sent to Attorney (or his designetl m D~stnct
c~ffire for ~nformaUonll purpoxs.
The "original" should be teturned by Ckrk of Cucuit Court to
tlie office originating the document.
a"Notice of Lien" hu been properly rccorded and then is paid
~n fu1! a"Satisf~ction of Lten" (HRS Form 560) should be filed
~ a ith the Clerk of Circuit Cuutt.
~ a"~lotice of Lien" has been prepared ~n rrr~.r, and recurdrJ, a
~ (_anrellation of Lien" (NRS Form 5611 ~huuld be filed with Ihc • '
~ ~ terk of the Circuit Court.
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