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NOTICE OF LIEN 5(~2~'~0
STATE OF FLORIDA
COUNTY OF ST. LUCIE
NOTICE is hereby given that pursuant to the provisions of
Chapter 65-2181, Laws of Florida, Acts of 1965, the Board of County
Commissioners of St. Lucie County, Florida, claims a lien in the
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amount of One Thousand and Forty Dollars and Txenty-five-Cents ;
1,040,25 ) Dollars against any real or personal property
or interest therein presently held or after acquired by
Lafayette-Davis of 2105 Ave. E, Apt. C, Ft. Pierce, F1. 33450
(Indigent or Recipient) (Address)
for money directly spent by St. Lucie County for the care, hospital-
ization, sustenance or maintenance of said Indigent or Recipient
of welfare assistance, as follows:
Hospital: Laxnxood Medical Center
Date~Admitted• k/14 /80 i
Date Discharged: I~~g/An
Number of Days: 5 at $ 208.05 per day = $ 1,040.25
Less Credits None
Amount of Lien ~ $ 1 ,040.25
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Dated at Fort Pierce, Florida, this ` x'f`' day of
t~-~ -,ti-- 19a o 1 ~ .
(Signature)
COUNTY ATTORNEY
(Title)
` ~~'T~ry d subscribed before me 19`~ -7 s ~
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:'L ` - SS.LUCIE CCJ`1T'Gi LR. '
_ :'t~it~ • - day of , 19g 0 rOGER P01 i R.:S r
_ _ yr? _ CLERK CIe~Ct11+ CG,. +]ffnn!!
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.ot.~c7.i.~'ublic State of Florida at Large 50~a~0
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