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IN THE CIRCUIT COURT, NINETEEN
JUDICIAL CIRCUIT, IN AND FOR
ST. LUCIE COUNTY, FLORIDA.
CASE NO. 79-450-CA
WALTER C. JONES and NOLA
JONES, his wife,
Plaintiffs,
vs
LAWRENCE WHITE, DADE PAPER
AND BAG CO., a Florida
corporation, and OLD REPUBLIC
INSURANCE CO., an insurance
corporation,
Defendants.
NOTICE OF PAYMENT OF COMPENSATION AND
OTHER BENEFITS UNDER THE FLORIDA WORKMEN' S
COMPENSATION LAW AND WORKER'S COMPENSATION LAW AND
CLAIM OF LIEN BY AMERICAN MUTUAL LIABILITY INSURANCE
COMPANY, CARRIER
TO: CLARENCE M. WOOD, ESQUIRE
333 E. Monroe Street
Jacksonville, Florida 32202
Attorney for Plaintiffs
. MICHAEL A. ESTES, ESQUIRE
P. O. Drawer 3751
Orlando, Florida 32802
Attorney for DADE PAPER AND
BAG CO. and OLD REPUBLIC
INSURANCE CO.
Each of you is hereby notified that American Mutual
i
Liability Insurance Company, as Workmen's Compensation Carrier
~ for the employer of the Plaintiff, Walter C. Jones, at the
time of the accident which is the subject matter of the
suit herein, has made the following payments under the Florida
Workmen's Compensation Law as a result of the alleged accident
and injuries to the Plaintiff, Walter C. Jones: compensation
in the amount of $3,370.50, medical benefits in the amount
3
of $2,212.65, all as a result of the alleged accident and
. .
injuries to the Plaintiff, Walter C. Jones.
f
f
~ Notice of the above payments of $3,370.50 and $2,212.65
totaling $5,583.15 is hereby given to each of you pursuant
a
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