HomeMy WebLinkAbout1128 / ~
4~~.s~~ ~
IN THE CIRCUIT COURT OF THE
NINETEENTH JUDICIAL CIRCUIT ~
IN AND FOR ST. LUCIE COUNTY,
FLORIDA
I CASE NO. 78-385-CA
i
DIXIE LEE MOORE, etc., : `
~ Plaintiff, ~ i
vs .
STATE FARM MUTUAL AUTO ,
INSURANCE COMPANY and
GENEVE L. CRISCI,
Defendants.
i
~
NOTICE OF LIEN FOR PAY24ENT OF COMPENSATION
' AND MEDICAL BENEFITS UNDER FLORIDA'S
WORKMEN'S COMPENSATION ACT
~3
. }j i
City Investing Company and Travelers Insurance Company, ~
f~ ~
r a foreign corporation authorized and doing business .in the State
of Florida, by and through their undersigned attorneys, pursuant
to Florida Statute §440.39(3)(a), hereby give notice that John J.{
1
Moore was, at the time and place he was injured as alleged in
the Complaint heretofore filed in this cause, in the course and ~
• scope of his employment and that the employer and insurance 1
carrier hereinabove named have paid to the said John J. Moore,
various sums of money for workmen's compensation benefits, in- ~
cludin tem orar total disabilit
g P Y y, permanent partial disability,
~
i medical benefits, death benefits, and all other benefits to 1
j~
which John J. Moore, deceased, and his survivors were entitled
E
under the Act.
j` ,
• WHEREFORE, City Investing Company and Travelers Insurance]
F
' Company, by and through .their undersigned attorneys, pray that
this Notice be filed in the above matter and be recorded by the '
s
Clerk of Court, and that the same, according to statute, consti-
tute a lien upon any recovery by the Plaintiff herein, for the
'i 3
full amount of the benefits previously paid to, or in behalf ~ '
4
of, John J. Moore, and his survivors, as prescribed by the
i
~i ' f
t ~
k 3U`7 1~.2~
c. 300K ?ACE
i
_ -