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IN THE CIRCUIT COURT OF THE 19TH
JUDICIAL CIRCUIT IN AND FOR ST.
LUCIE COUNTY~ STATE OF FLORIDA.
CASE N0. 78-312-CA
ANTHONY NOR24AN ,
Plaintiff,
V.g .
KROEHLER MANUFACTURING COMPANY
and RICHARD FRACARO~
Defendants~_
vs.
FRANK WILSON HOGAN,
Third Party Defendant.
NOTICE OF PAYMENT OF WORKMEN'S
COMPENSATION AND MEDICAL BENEFITS
AND
CLAIM OF LIEN THEREFOR
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Comes now HAVERTY'S FURNITURE COMPANY~ Employer, and INTER-
NATIONAL INSURA.'JCE COMPANY, Workmen's Compensation Carrier for
the said Employer of ANTHONY NORMAN, Plaintiff in the above-_ .
styled cause, by and through their undersigned attorneys, and
pursuant to Section 440.39. Florida Statutes, files and gives
this, their notice of payment of compensation and medical benefits
paid and/or to be paid to or on behalf of the said Emnloyee,
ANTHONY NORMAN, the Plaintiff herein.
WHEREFORE, HAVERTY'S FURNITURE COMPANY and INTERNATIONAL
INSURANCE CO*iPANY hereby affirm and assert their lien up6n any
judgment or settlement recovered by the Plaintiff, ANTHONY NORMAN;
against the above-named Defendant and Third Party Defendant, to
the extent that the Court may determine as their pro-rata share
of said judgment or settlement for compensation and medical
benefits paid and/or to be paid under the provisions of Chapter
440, Florida Statutes.
I HEREBY CERTIFY that a true copy of the foregoing has been
P R E NNAN a MUSCMOTT
l~Al/E11t
't5 DELMa1tE AVEMUE
sp~T MEIICE. i101110A
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furnished by mail to John F. Romano, Esq., Attorney for Plaintiff,
Post Office Box 3466, West Palm Beach, FL, 33402, John P. Wieder-
hold, Esq., Attorney for Kroehler and Fracaro, Citizens Building.
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