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IN THE CIRCUIT COURT OF THE
FIFTEENTH JUDICIAL CIRCUIT, ,
IN AND FOR ST. LUCIE COUNTY,
FLORIDA. CIVIL ACTION
NO. 77-270 CA Nourse
JACK A. RUSSELL and ;
CARMEN VALLARTA RUSSELL, :
. NOTICE OF PAYMENT
~ Plaintiffs, : OF
. WORKMEN'S COMPENSATION
vs. . AND
. MEDICAL BENEFITS
FLORIDA EAST COAST . ~D _
RAILWAY COMPANY, a : CLAIM OF LIEN THEREFOR
Florida Corporation, :
Defendants. :
MAULE INDUSTRIES, employer, and INSURANCE COMPANY OF NORTH
AMERICA, workmen's compensation carrier for the said employer
of JACK A. RUSSELL, plaintiff in the above styled cause, by
and through their undersigned attorney and pursuant to Section
440.39(3), Florida Statutes, file their notice of payment of
compensation and medical benefits paid and/or to be paid to
or on behalf of said employee and/or plaintiff.
WHEREFORE, MAULE INDUSTRIES and INSURANCE COMPANY OF NORTH
AMERICA hereby affirm and assert their lien upon any judgment
or settlement recovered by the above-named plaintiff against
; the above-named defendant to the extent that the Court may ~
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' determine as their pro rata share of said judgment or settlement ~
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i for compensation and medical benefits paid and/or to be paid ~
g under provisions of Chapter 44Q., Florida Statutes. ~
t I HEftEBY CERTIFY that a copy of the foregoing has been ~
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a ~
~ mailed to: Christian D. Searcy, Esquire, Attorney for Plaintiffs -
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~ and George H. Moss, Esquire, Attorney for Defendan+-s, this 29th
~
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~ •day of March, 1979.
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' C=U'~i~ ~L~.. Y D RO INS
~L-,. - . . 2247 Palm Beach Lakes Blvd.
? 43~~~ West Palm Beach, Florida 33409
'79 aF~ Z~ ~I:Zy Attorney for Employer/Carrier ,
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