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. • STATE OF FLORIDA
' = DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
~~r,,.'~ TALLAHASSEE 32301
NOTICE of LlEN
Client Number C 100 330
~U~~~ Lien Number 2-65
Pursuant to the provisions of Section 402.33(7) (a). Florida Statutes, notice is hereby given that there have been •rssessed,
pursuant to provisions of said law, against Davi d 0' Nei 1~ Pri nce
a liability for payment of fees to the Ftorida Department of Nealth and Rehabilitative Services, pursuant to the pravisions of said
lew, the sum of S~. A94 _(10 unpaid fees, which after demand for payment ihereof remain unpaid, and that by virtue of the
above mentioned law the amount of said fee, constitutes a licn in favor of State u[ Florida Department of tiealth and Rehabilitative
Services upon any title or interest,. whether legal or equitable, in any real property, chattels real. or personal propeny of said client
or responsible party.
Periods for which fees have been assessed, and the amounts thereof, are as follows:
Month;Year Fee Assessed Month/Year Fee Assessed
July 1, 1977 - March
31, 1978 @ ~210.00 1,890.00 4U1'~4~3
Filing Fee 4.00
F~~EO ~?NO aECOpoEo
ST. LtlCIE COUNTY ftA.
ROCER POITRAS
C! ~ ~ t ; ~ ~CUiT ~
_ . F~F •
~~f ~ ~ ~ 20 AH'~~
Total S 1,894.00 =
This I9 day uf ~.AI]1^7' 1 , A.D. 19~_ . '
This Instrument prepaced by STATE OF FLORIDA DEPARTMENT OF HEALTH
AND HABILITATNE SE~VICES
Terry Nolt, Cashier, Florida State Hospital ~
(?~ame) ~ ~
Chattahoochee, Florida 32324 Administrator
(^da~eu? Florida State Hospital
HRS FORM 540. Jul 77 ~~R~ 2~ y!1.,?