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STATE OF FLORIDA ~ /
, ut~ARTMENT OF LABOR AND EMPLOYMENT SECURITY
DiVISiON OF UNEMPLOYMENT COMPENSATION
BUREAU OF TAX ~
TALLAHASSEE, FLORIDA 32301
TE L. 904/48$-7621
NOTiCE OF TAX LIEN
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Pursuant to the provisions of Sect~on 443.141 {3) (a) and (y) Florida Statutes, known as the lien prov~s+ons of the Florida Unem-
;:i~yment Compensat~on Law, nouce is hereby given that the above named employer is liabie for the payment of contributions to the -
iJr~empioyment Compensation Fund of Florida. Pursuant to the provisions of sa~d law, the following contributions, interest, penaliies,
:~~~_i fees wh;ch after demand for payment thereof remain unpaid, and that by virtue of the above mentioned law, the amouni of said
r~ntribuIions Itaxes) together ~vith ~nt~rest, penaities, and other costs that may accrue in addit+on thereto, constitute a lien in favor
,f STA7E OF FLORIDA DEPARTMENT OF LAE30R Af~n EM?LOYMENT SECURITY upon the titte to and interest, whether lega!
~r equitable, in any real property, chattels r~ai, or personai property of sairl employer.
Periucis tor which contributions, intarest, pr~nalues, and fees have been assessed, and the amounts thereof, are as follows:
~ QlYR i TAX DUE -r iNTEREST THROUGH ~ PENALTY SERVICE FIUNG s
~ 11/Ol/b4 DUE FEE FEE I
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TOTA~ AMOUN7 OF TAX LIEN ~ i c. 1 t;
~~'J;TNESS THE OFFICIAL SEAL OF THE STATE OF FLORIDA DEPARTMENT OF LABOR AND EMPLOYMENT
`:~-CURITY, DIVISiON OF UNEMPLOYMENT COMPENSATION, at Talfahassee, Florida, this j= j
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of tvL~VtME:Eh , A.D. 19 ~4 .
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t' ~ AGENCY USE ONLY
~,~~~4~~ Y!rt 98~ ~ ~ z 4" ~ REMIT NO. OATE 11/14/84
J y _ ~ ~s AMT. y NO PAY.
`''y'` ,~3 P.M. DATEFILEp 11/14/8~
- ~ REPORTS F.A. D3V~S
This instrument prepared by: ~ ~
~
~tfjkL~Y L~NARG F.O. NO. ~-~A L. ONIY O. INDEBT:~
Departrneni of Labor and Employment Security
Caldwell Bldg., Tallahassee, Fla.
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