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STATE OF FLORIDA 5~~6
t"HS `Of REV eiie- DEPARTMENT OF LABOR AND EMPLOYMENT SECURITY `'~
DIVISION OF crtIPLUYMENT SECURITY
TALLAHASSEE 32304 Account Nn. 4 6 0 2 4 0
NOTICE OF TAX LIEN ~.ICn Nu. 0-17676
J E O P A R D Y
Pursuant to the provisions of Section 443.15 (3) (o), 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 Two and Three Company (A FL Corp. )
T/A Embers
1812 South Federal Highway Ft. Pierce, Florida 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 1746.65 covering the following
contributions, interest and penolties, which offer demand for payment thereof remain unpaid, and that by virtue
of the above mentioned law the amount of said contributions (taxes), together with penolties, 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.
Periods for which contributions, interest, and penalties have been assessed, and the amounts thereof, are
os follows:
QUARTERIS) INTEREST THROUGH
QTR. YEAR TAXES
9 30 80 PENALTIES
2 80
SERVICE FEE 1714 50 17 15 15 00
ToTAI_ 1714 50 17 15 15 00
WITNESSTHEOFFICIAL SEAL OF THE STATE OF FLORIDA DEPARTMENT OF LABOR AND EMPLOY-
MENT SECURITY, DIVISION OF EMPLOYMENT SECURITY at Tallahassee, Florida,
this 13 day of October A.D. 19 8d• -r'-~t~ ~ .;~ aS(~~
SEA4` ! ~~
-' - ~ - S1tlE0 FE 0
• Y~;.., ~OINti
This instrument prepared by: ;''.: •~ ~~RO t'FRIFIFR ~~av~
Barbara A. Peterson
Department of Labor and Employment Security
Caldwell Bldg., Tallahassee, Fla.
X11344 P~ 77~