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AFFIDAVIT
STATE OF FLORIDA ' ;
COUNTY OF ST.~LUCIE
Re: lot 4, Block 22, LAKEWOOD PARK
UNIT 3, as per plat thereof on
file in Plat Book 10,'pages 63
and 64, of the Public Records
of St. Lucie County, Florida.
6efore me, the undersigned authority, personally appeared '
Robert C. Lewis, who, upon first being duly sworn, did depose and say:
Affiant states that he is aware of a certain lien filed
against Robert Lewis by the Board of County Comnissioners of St. .
Lucie County for ~1,804.00, for a hospital bi11 for care at Fort
Pierce Memorial Hospital.
Affiant further states that he is not the person named
in that particular lien and has never been a patient in Fort Pierce
Memoriai Hospital.
Further affiant sayeth 110t.ever used 436 N. lOth Street as a
mailing address in Fort Pierce, Florida.
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Robert C. Lewis ~ ~
~Sworn~to ar~d subscribed before me
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F{LfD A~10 RECOiIDED
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