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STATE OF FLORIDA 4~~~ ~ /
i.t•:s =opEY,,e-~~e, DEPARTMENT OF LABOR AND EMPLOYMENT SECURITY
' DIVISION OF EMPLOYMENT SECURITY
TALLAHASSEE 32301 Account No. 701227
NOTICE OF TAX LIEN `-'ern No. 0-3067
J E O P A R D Y
Pursuant to the provisions of Section 443.15 (3) (a), Florida Statutes, known as the Florida Unemployment
Compensation law, notice is hereby given that there have been assessed, pursuant to the provisions of sold law,
against Leroy Bellamy - -
r
2114 N 43rd Street
Ft. Pierce, Florida 33450
an "employer" liable for the payment of contributions to the Unemployment Compensation Fund of Florida,
pursuant to the provisions of said law, the sum of S 8~9-98 covering the Following
contributions, interest and penalties, which after demand for payment thereof remain unpaid, and that by virtue
of the above mentioned law the amount of sold contributions (taxes), together with penalties, interest, and costs
that may accrue in addition thereto, constitute a lien in favor of STATE of FLORIDA DEPARTMENT, of
LABOR and EMPLOYMENT SECURITY upon the title to and interest, whether legal or equitable, in any real
property, chattels real, or personal property of said employer.
Periods for which contributions, interest, and penalties have been assessed, and the amounts thereof, are
as follows:
oUARTERIS) TAXES INTEREST THROUGH PENALTIES
pTR. YEAR 2-29-80
~ 3 79 ( 27 54 5 55 5 00
4 ~ 79 I 54 17 2 72 5 00
E
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- ~ iI
I ; ( ~ I.
a ~
SERVICE FEE _ _
ToTA~ 82 71~_ 8127 _ 10 00
g
WITNESSTHEOFFICIAL SEAL OF THE STATE OF FLORIDA DEPARTMENT OF LABOR AND EMPLOY-
; MENT SECURITY, DIVISION OF EMPLOYMENT SECURITY, at Tallahassee, Florida,
this 3 day of "larch , p.p. 1q 80 4~~
~ Mai 2EI PM 2 24
0R0~
SEAL s~~T.FjA.
x
gt.EilK CIRCUR RA
#ifC~tg VERfFfEO
~ This instrument prepared by:
TerLy Miller '
Department of Labor and Employment Security ~ ~ B~~ pp~f~•3
Caldwell Bldg., Tallahassee, Fla.