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STATE OF FLORIDA
t'~s `°~E~ siie? ~ DEPARTMENT OF LA~30R AND EMPLOYMENT SECURITY
DIVISION OF EMPLOYMENT SECURITY
TALLAHASSEE 32301 Account No. 496160
NOTICE OF TAX LIEN Lien No. - - 0-15904
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 said law,
against Mildred I. Amos -
T/A Permit Services
P. 0. Box 60b - 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 104.68 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 title to and interest, whether legal or equitable, in any real
property, chattels real, or personal property of said employer.
j Periods for which contributions, interest, and penalties have been assessed, and- the amounts thereof, ore .
~ as follows:
~ QUARTER(S) INTEREST THROUGH '
TAXES PENALTIES
qTR. YEAR - -
2 79 (Bal.) 28 15 1 83 -
3 79 44 96 2 25
~ 4 79 ~ 26 56 93 -
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SERVICE FEE }
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TOTAL 9 9 6 7 5 O 1 ~
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WITNESSTHEOFFICIAL SEAL OF THE STATE OF FLORIDA DEPARTMENT OF LABOR AND EMPLOY-
~ MENT SECURITY, DIVISION OF EMPLOYMENT SECURITY, at Tallahasseg, Florida, i
~ this 24 day of September , A.D. 19 80 `
504145 190 OCT 2 t ~ ~ 5S : -
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i1lEi'thC kfCQitUEO ` . s~
SLLUCIE000NiYY.fIA. t+,;
RCrGER POITRAS '
This instrument prepared by: CLERK CIRCUIT CO fj . ~h - .
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~ Larry Johnson ~ •.`y r- f
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Department of Labor Qnd Employment Security r
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Caldwell Bldg., Tallahassee, Fla. ~ - , d00K~~.
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