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STATE OF FLORIDA
. DEPARTMENT OF ~ABOR AND EMPlOYMENT SECURlTY
, . - DIVISION OF UNEMPLOYMENT COMPENSATION
BUREAU OF TAX
TALLANASSEE, FIORIDA 32301
TE L. 904/488-7621
6~~8fi'7 NOTICE OF TAX LlEN
~ V I CiitC~i~t INi: Account Number _ ~
_ t ~
21:: SDli7N1?c:~T Cr2E5Eh7 AVEt~U~
F~GS~T ST LU:.if: FL 3.s452 LienNumber 4-~~li..
o•••~..,~+ rho n.nwci~ns of Section ~143.141(3) and 1y? Florida Statutes, known as the tien provisions of the Florida Unem- I
;~~:~yment CompensaUOn Law, i~oticer is hereby given that the above named employer is I+able for the payment af contribuUons to the
Unemployme~t Compensation Fund of Fiorida. Pursuant to ihe prov~sions ot sa~d law, the following contributions, interest, penaities,
,,nd fees which after demand tor payment thereot remain unpaid, and that by viitue of the above mentioned law, the amount of said
~ or~tributions (taxes) together ~vith intPrest, penaities, and other costs that inay acuue in addition thereto, constitute a lien iii favor
:t STATE OF FLORIDA D~PARTMENT OF LABOR AND EMPLOYMENT SECURITY upon the titie to and interest, whether legal
~r ec~uitable. in any real property, chattels r~~al, or personal prope:ty of said employer.
?eriocis fo~ .vhich contribui~ons, inla~::52, pen::lties, and fees have been assessed, and the amounts thereof, are as follows:
Q/Y~ TAX DUE-T INTEREST THROUGH PENALTY SERVtCE FIUNG ~
OUE FEE FEE
; ; 2!/al/L34
, I ~
t~~i4? A( 3•00 ~ .0~ 1~•Cti
1 ~ ~ ~
;
' ~ ~ '84 16 A11:11 ~
' ` ~
i i ~
~ : ~i~_c - ~ - ~
' ' ROuER F' ~ ' t~!`~
~ i _
~ ~ ~ ST. LUCI ~ - ~
~ ' ;
, ; I
~ ~ !
; ~
I i I bf~Q86'~
~
' ~ {
! I
~ ; ;
i i I
- ~ - -
TOTAL AMOUNT OF TAX LIEN 1~• ~
V`dlTNESS THE OFFICIAL SEAL OF THE STATE OF FLORIDA DEPARTMENT OF LABOR ANC EMPLOYMENT
";t=CURITY, DlVISION OF UNEMPLOYMENT COMPENSATION, at Tailahassee, Florida, this i~ t
'~ti' Of ~`'uVt~+lticM ~ A.~. 19 a4 .
Ftir~~~rL Q~~£ W~ T~ ~ AGENCY USE ONLY
~~.ZV VV
~ - - R REMIT NO. DATE 11~'1 ~4~ 8~e
~ ~ AMT. $ NO PAY.
+~r'~~~~~' ~ P.M. DATE FILED ~I~l~~
~ ~
y ~n REPORTS F.A. Da,VIS
~fh~s ~nstn;ment prepared by: ~ ~
~i7tFiLEY Ltt,:NO.Ru [-~A k X
_ F.O. NO. - l. OMLY A-- O. INQEST._ I
Department of Labor and :mployment Seturity
~~i.~wp~~ Rlrla.. Tallahassee, Fla.