HomeMy WebLinkAbout1487 ' 4 ~
4.211
65ORANCE '
~ 1111 f Transferred to Circuit Court,
n~pp ~ Y St. Lucie County, Florida
C.R. ~~.y0 ri 441 C IN THE CIRCU T OURT, NINETEENTH
JUDICIAL CIRCUIT, IN AND FOR
ORANGE COUNTY, FLORIDA
CHARLES GARY WILHELM,
CASE NO: CI 79-11436 i
Plaintiff, ~
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vs. f> ~ °D
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GROSE INTERSTATE MOVING AND C-'
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Defendant. '
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A o Gt.;
N C-~
NOTICE OF VIORKER'S COMPENSATION LIEN i
COMES NOW, Georgia Highway Express, Inc., a self-insuror, authorized
to do business and doing business in the State of Florida, by and through
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~ its undersigned attorneys, and files this Notice of Worker's Compensation
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Lien pursuant to the provisions of Section 440.39, Florida Statutes,. and
~ would .show to the Court the following:
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1. That at the time of the occurrence alleged in the Claim filed
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in the above cause, the Plaintiff was an employee of Georgia Highway
~ Express, Inc., which company was self-insured for workmen's compensation
purposes;
2. That at the time of the occurrence alleged in the Claim,
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CHARLES GARY WILHELM was within the scope and course of his employment
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f with Georgia Highway Express, Inc.;
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j 3. -That by reasons of injuries sustained by CHARLES GARY WILHELM
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! arising out of the aforesaid occurrence, Georgia Highway Express, Inc.,
pursuant to the provisions of the Florida Worker's Compensation Law,
Chapter 440, Florida Statutes, as of December 1, 1979, has expended the
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sum of Two Thousand Seven Hundred Fifty-Six ($2,756.00) Dollars for
' compensation benefits and Three Thousand Five Hundred Seventy-One and
85/100 ($3,571.85) Dollars for medical payments to CHARLES GARY WILHELM
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for which they are herein filing their lien pursuant to Section 440.39
of the Florida Workmer's Compensation Act. Georgia Highway Express, Inc „
is continuing and will continue to expend additional monies for compen-
sation benefits and medical payments for which they are herein giving
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' notice of their intention to claim a lien in addition to-the sums
specified herein.
aroK3~4 Q~E~4~ fE6 2 6 1980
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