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STATE OF FLORIDA ~ ~
DEPARTMENT OF LABOR AND EMPLOYMENT SECURITY
_ , DIVISION OF UNEMPLOYMENT COMPENSATION
BUREAU OF TAX
TALLAHASSEE, FLORIOA 32301
TE L. 904/488-7621
4it3~85~ NOTICE OF T~X LIE(~0
'.;~!Uy':'f:
Gf.EEP ACkE 5GG IhC Account Number `~t~c 1
tiCO rALTLRS 7t12l-.
NLkT 57 LUGiE 1=L ~~45~ LienNumber ~;-~~~~c ~
Purs~ant to the prov~sions of SecUOn 443.141(3) (a) and (y) Florida Statutes, known as the lien provisions of the Florida Unem-
;~loymeni Compns~;auon Law, noticfr is hereby given that the above ~amed employer is fiable for the payment of contributions to the
Unemployment Compensa:ion Fund of Florida. ~ursuanc to ine pro~isions o( sa~u iaw, 111~ 1UlIUtitiltly t.l7i~liiuiiiiu~~~, iiii2ic5i, jn,ia'iiic3,
and 'ees r~hich after demand for payment thereof remain unpaid, and that by viriue of the above mentioned ~a~v, the amount of said
cor:inbutio~s (taxes) together with intc•rest, penalties, and ather costs that may accrue in addition thereto, constitute a lien in favor
STATE OF FLORIDA DEPARTI4IENT OF LABOR AND EMPLOYMENT SECURITY upon the title to and interest, whether legat
equitable, in any real property, chattels real, or personal property of said employer.
Pericxls for which contributions, ~ntaresc, p~•nalties, and fees have t~een assessed, and the amounts thereof, are as follows:
~ QJVR-T-- TAX DUE INTEREST THROUGH PENALTY SERVICE FIUNG
; ~ I OUE FEE FEE
: ; 11/G 1/~4 I
S -~---1--
f ~ -
K~ :s4 A i b 7"L. 52 10. 09 ~ u~%
~ ;
' ~ '84 i~Y,16 ~1 :10 ~f
f ~ ; I a
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t ! ! I ROGER r:: . r.: I
~ ~ ST. LUCI~ C ~
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TOTAL AhtOUNT OF TAX LIEN ~y 7• c. 1
F ;vITNESS THE OFFICIAL SEAL OF THE STATE OF FLORIDA DEPARTMENT OF LABOR AND EMPLOYMENT
,~CURlTY, DIVISlON OF UNEMPLOYMENT COMPENSATION, at Tallahassee, Florida, this i--~
of n~vtMt~n A.D. 19 ~t4
,
" • ~ AGENCY USE ONLY
~ ~ ~ - c~+ REMIT PiO. OATE 11 1
~ _ . ~~O P..~~ ~(~sJ ~ : ~ ~ ~ I
; NO P.4Y.
~ T. u" I AMT. 5
0
~ k-,"~~~~~' ~ i P.h1. DATE FILEO 11 1
' Fh i REPORTS F.A. Davis
g rh~s instrurnent preoared by: ~ ~
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:t~L hLtY L"tONAkG I F_O. NO. ~-LA 5Q L. ONLY O. INDEF3T.~
Department of Lanor and Employment Secunty
~ Catdwell Bldg., Taliahassee: Fla.
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