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444492
IN THE CIRCUIT COURT OF THE
NINETEENTH JUDICIAL CIRCUIT
IN AND FOR ST. LUCIE COUNTY,
FLORIDA
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CASE NO. 77-326-CA
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MICHAEL J. McCARTHY, -
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Plaintiff, NOTICE OF LIEN FOR PAYMENT
OF WORKMEN'S COMPENSATION
vs. BENEFITS AND REQUEST FOR
JUDICIAL NOTICE OF CALIFORNIA j
LIBERTY MUTUAL INSURANCE . LA~~T
COMPANY, et al, ~
~ Defendant. ~
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NOTICE OF LIEN FOR PAYMENT OF - ~
° WORKMEN'S COMPENSATION BENEFITS _ ~
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TRANSPORT INDE?~lNITY COMPANY and BEKINS VAN LINES
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hereinafter known as "Lienors", serve this their notice of
payment of workmen's compensation benefits upon all parties
herein and would show unto the Honorable Court as follows:
1. That TRANSPORT INDEMNITY COMPANY is, and was
` at all times material hereto, authorized to provide workmen's
compensation insurance in the State of California;
2. That TRANSPORT INDEMNITI' COMPANY was, on
February 11, 1976, the workmen's compensation carrier for
BEKINS VAN LINES;
3. That on or about February 11, 1976, MICHAEL J.
McCARTIi-Y, the Plaintiff herein, was employed by BEKINS VAN
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LINES and on that day sustained an accident resulting in
a
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- injuries under circumstances entitling him to the benefits
provided by the Workmen's Compensation Act of the State of
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California; further, that the Plaintiff herein now seeks to
recover damages from the Defendants for injuries sustained
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in said accident;
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4. That TRANSPORT INDEMNITY COMPANY has paid to,
or on behalf of, MICHAEL J. McCARTHY, certain monies in
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accordance with said California Workmen's Compensation Act
in the amount of $4,602.24 as evidenced by true copies of
payment drafts which are attached hereto and expressly in-
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corporated by reference herein as Lienors' Exhibit "A".
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