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STATE OF FLORIDA
. . . DEPA~iTMENT OF LABOR AND EMPLOYMENT SECURITY
. ~ DIVISION OF UNEMPLOYMENT COMPENSATiON
BUREAU OF TAX
TALLANASSEE, FLORIDA 32301
TE L. 904/488-7621
6~3~s~9 NOTICE OF TAX LIEN
E_n,F,i~yer~
~ HLLa.FY SuU tN~ Accoun, Number
~ E.GS..`.c.4
c/o 2417 St. Lucie Blvd.
FT PIcRCE FL "3~~~?5:1 LienNumber 4-.:a~>~
Pursuant to the provisions of Seci~on 443.141(3) Ia) and (y) Florida Statutes, known as the lien provis+ons of the Florda Unem-
;>loyment Cornpensat~on Layv, notice is hereby piven that the above named employer is liable for the payment of contributions to the
Unemployment Comperisation Funci of Florida. Pursuant to the provisions o', said law, the following contributions, interest, penalties,
and fees whict~ after demand for payment thereof rert~ain unpaid, and that by virtue of the above mentioned law, the amount of said
r.ontributions (taxes} together wiih ;nt~rest, penaities, and other costs that may accrue in adclition thereto, consti.ute a lien in favor
of STATE OF FLORIDA DEPARTMENT OF LABOR AND EM?LOYMENT SECURITY upon the titfe to and interest, whether legal
or eyuitable, +n any real property, chattels real, or personal property of said employer.
i Periods for which contributions, irter~:st, penalt~es. and fees have b2en assessed, and the amounts thereof, are as follows:
i Q/YR TAX DUE INTEREST THROUGH PENALTY SERViCE FIUNG ~
~ 11/O1 /t34 DUE FEE FEE
; ~ ~
; ~ 1
~
6 . t/c~4 A~ 1 T6.8fl i ~.~5 1~.00
~ ~ ~ '84 16 I~1 ~11 i
~ ; i ~ ~
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~ ~ ROGEk ; ~ • t;
~ : ~ ~ SL LU << : ~
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~ ~ ~ 6~3~8~
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TOTAL AMOUNT OF TAX LIEN 1; 4. 4_
` 1~VITNESS THE OFFlCIAL SEAL OF THE STATE OF FLORIDA DEPARTMENT OF LABOR AND EMPLOYMENT
~;E_CURITY, DIVlSION OF UNEMPLOYMENT COMPENSATION, at Tallahassee, Florida, this 1~-r
';v
of ~L~•r~M~~R , A.D. 19 co
d~~~F
~ 3 ~ ~ AGENCY USE ONLY
~ ~
~ „ ~.f ~ ~ ~ - " REMIT NO. DATE 11 1 ~
~ c.__K Y..o~ _
~ ~si - AMT. S NO PAY.
~
, ~ ~ P M. DRTE FILED
; ~ ~ REPORTS ~_A. Davis
This instrument re ared b ~ ~
~ P P Y~ Se~
~ _ tiHI r'~EY ~.tti(dAfcU F.O. NO. '~-2~ L ONLY O. INDEBT.~`
~ Departrr,ent of Laber and Employment Security ~
~ Caldwelt 61dg., Tallahassee, Fla.
~
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