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STATE OF FLORIDA
t•~ `°~E~ a;;~, DEPARTMENT OF LABOR AND EMPLOYMENT SECURITY
DIVISION OF EMPLOYMENT SECURITY
TALLAHASSEE 32301 Account No. 15 7 4 71-A
NOTICE OF TAX LIEN i•~en No. o-bale
J E O P A R D Y
Ps~:suant to the provisions of Section 443.15(3) (a), Florida Statutes, known as the Florida Unemployment
Compensation law, notice is hereby given that there hove been assessed, pursuant to the provisions of sold low,
against Bugene J . Horn
T/A Donut Fair
1109 N. 4th Street Ft. Pierce, Fla. 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 150.35 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 said 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 titie 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:
QUARTER(S) TAXES INTEREST THROUGH PENALTIES
QTR. YEAR
2 79 48 60 1 94 25 00
3 79 48 60 1 21 25 00
~ ~ 4
~ I ~~820
~ ~ aE0 UN -6 AM ifs 36
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S R D ~ A. ~
GRCINT ~
Glt9 YE 1F1E0
~ SERVICE FEE
TOTAL 97 20 3 15 50 00
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rc WITNESSTNEOFFICIAL SEAL OF THE STATE OF FLORIDA DEPAR7M.~NT OF LABOR AND EMPLOY-
MENT SECURITY, DIVISION OF EMPLOYMENT SECURITY, of Tall ~otida,
this 23 day of Avril , A.D. 19 80 _ ~;~h'--~,
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This instrument prepared by: ~ ~ ~ - _
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Lisa Magill
Department of Labor and Employment Security a0Q(~~ P~GE~~~
Caldwell Bldg., Tallahassee, Flo.
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