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STATE OF FLORIDA
.,;,,,;,,rt DEPARTMENT OF LABOR AND EMPLOYMENT SECURITY
. DIVISION OF UNEMPLOYMENT COMPENSATION '
BUREAU OF TAX I
TAILAHASSEE, FLORIDA 32301
L~nQ Cr TE L. 904/488-7621 I
V il(7J0
NOTICE OF TAX LIEN
- ;n'over.
EMM I77 BRGWN Account Number q 13346
EMMI7T BRC1tN CGKSTRL'CTI CN
1T0(? N 29TH 57 Lien Number 4- ;E565
FC~RT r-i ci«~ FL 33A50
Purs~ant to the prov~s~ons of Section 443.141 ~3) (a) and ly) Florida Statutes, known as the lien provisions of the Florida Unem- .
,~loyment Compensanon Law, notice is hereby given that the above named employer is liable for the payment of contributions to the
Unemployment Compensation Fund of Florida. Pursuant to the provisions of said law, the following contributions, interest, penalties,
and fees which after demand for payment thereof remain unpaid, and that by virtue of the above mentioned la~v, the amount of said
contributions (taxes) together tivith ~nterest, penaities, and other costs that may accrue in addition thereto, constitute a lien in favor
.,f STATE OF FLORIDA DEPARTMEiVT OF LABOR AND EMPLOYMENT SECURITY upon the titte to and interest, evhether lega!
or equitable, in any real property, chaitels real, or aersonal property of said employer.
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Periocls for whiCh contrib~tions, +nt~rest, penalties, and fees have been assessed, and the amounts thereof, are as follows:
QlYR-~- TAX DUE ~ INTEREST THROUGH PENALTY SERVICE FIUNG ~
OUE FEE FEE
I 21/O1/84
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: ~2/84 /1 i 12.~0 l.fi9 l5•00
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; ; i ~1r 16 ~1 ~ 10
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- TOTAL AMOUNT OF TAX LIEN 129~ i~
~.:~ITNESS THE OFFICIAL SEAL OF THE STATE OF F~ORIDA DEPARTMENT OF LABOR ~4ND EMPLOYiVIENT
~ CURITY, DIVISION OF UNEMPLOYMENT COMPENSATION, at Tallahassee, Florida, this STM
:;a,~ of hOVElIBER , A.D. 19 84
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~ ~ } ~ AGENCY USE ONLY
' ~ v'~K ~~S P~~C ~ REMIT NO. DATE 1
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Q ~ AMT. S NO PAY.
Yj P.M. ~ATE FILED 11 1~
~ REPORTS F.A. DaV1S
' This mstrument prepared by: ~ ~
~
~ ~hiRLEY LEGtiI1kD F.O.NO. ~-2A 5b ~.ONIY O.INOEBT.
s Department of Labor and Employment Security
s Caldwell Bldg., Tal~ahassee, Fla.
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