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IN~THE CIRCUIT COURT IN AND
FOR ST. LUCIE COUNTY, FLORIDA
CASE NO:
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LESTER LEE WILSON, -
Plaintiff, .
vs.
RONALD DEAN RADNEY and
PRIDGEN & SONS, It1C.
Defendants.
/
3
I~(OTICE OF PAYMENT OF COMPENSATION AND MEDICAL BENEFI'~S '
AND ~
CLAIM OF LIEN THEREFOR
Tne FLORIDA FARM BUREAU INSURANCE COMPANY,_ worker's
compensation carrier for the above-captioned Plaintiff,
LESTER LEE WILSON, by and through its undersigned attorneys
~ and pursuant to §440.39(3),~Florida Statutes, hereby gives
o ~
notice of payment of compensation and medical benefits paid ~
~ N
or to be paid to or on behalf of the Plaintiff under
A ~ Chapter 440, Florida Statutes. _
a? o
~ w WHEREFORE, the FLORIDA FARM BUREAU INSURANCE COMPAi1Y
~ o o hereby affirms and asserts its lien upon any judgment or
v ~d
N~ settlement recovered by the Plaintiff in this case to the
'~"M o extent that the Court may determine its pro-rata share of
said judgment or settlement for compensation and medical
.a _
w benefits paid or to be paid by the lien-claimant under the
~ provisions of Chapter 440, Florida Statut s.
aai -
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1-1 i~~U n:~~: C
HERB T G TON, J
s1.t-t;~c~ t``~` Y•' ~ ` Driscoll Lan ston
~cc~<<, N~itn ,s - g Lay n & Kane , P . A .
~ Ear c'z~u~; ~K; 3222 Corrine Drive
~ ~ Orlando, Florida 32803
~ ~ ~,3~6~ Attorney for Florida Farm Bureau Ins. Co.
305/894-8821
x
STATE OF FLORIDA ,
COUNTY OF ORANGE
Before me personally appeared HERBERT A. LAiJGSTON, J~~-, ~ who
being first duly sworn, deposes and sayts hat he exe~t~t~~~-~`~,~ta,,~
foregoing as representative of Florida•'F Bureau l~`;~~..~o'~, .
Sworn to and subscribed before s t -
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- •~L~y 4 ) 1 ~ 1
.~Iy Commi ion ,
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