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STATE OF FLORIDA ~
LES FORM 11~T 18 DEPARTMENT OF LABOR AND EMPLOYMENT SECURITY s~
(REV. 9184) DIVISION OF UNEMPLOYMENT COMPENSATIOM
BUREAU OF TAX -
TALLAHASSEE, FIORIDA 32301
TE 904/488-7621
NOTICE OF TAX LIEN P2~
Empiuyer. fiLEU ,:?d~ ;'t'~
EMMITT eROYN Account Number 4=y~6 ~R PiJt! •-..t ~ RK
ENMIT? 6i'~~M GOIiSTAtiCTION `~IE CUI,~N's
1TOa M l9Zi! ET Lien Number E~1~6~1
FORT ~ P~ERCE F~ aar?so ~,~2,~,3
Pursuant to the provis~ons of Sect~on A43.141(3) (a) and (y) Florida Statutes, known as the lien provisi~ns of tt~e Flwida Unem-
ploymer.t Compensat~on Law, notice is hereby given that the above named emptoyer is liable for the payment of contributions to the
Unemployment Compensation Fund of Florida. Pursuant to the provisio~s of said law, the following contributions, interest, penalties,
and feas rvhich after demand for payment thereof remain unpaid, and that by virtue of the above mentioned law, the amount of said
contributions (taxes) together with interest, penalties, and other costs that may accrue in acidition thereto, constitute a lien in favor
of STATE OF FLORIDA DEPARTMENT OF ~ABOR AND EMPLOYMENT SECURITY upon the title to and interest, whether legal
or equitable, in any real property, chattels real, or personat property of said employer.
Penals for which contribuUOns, interest, penalties, and fees have been assessed, and the amounts thereof,.are as follows: '
~ Q/YR TAX DLIE INTEREST THROUGH PENALTY SERVICE FILING
~ O~~~l~ DUE FEE FEE
/84 71.T2 -i•OS 1S•00
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TOTAL'AMOUNT OF TAX LIEN _ e?~~O
WITNESS THE OFFICIAL SEAL OF THE STATE OF FLORIDA OEPARTMENT OF LABOR ANO ~T~LOYMENT
SECURITY, C~IVISION OF UNEMPLOYMENT COMPENSATION, at Tatlahassee, Florida, tt?is
ciay of Y , A.D. 19 ea
d a~'~
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g v ~ i~- A(3ENCY USE ONLY
E - REMIT Np. UATE ~~ZZLHS
QQ s1 ~ ~ AMT. S NO PAY.
~ BnoK~6~ PAGE Vll~ ~ ' . . ~ P.M. DATE FILED ~~?l~ ~
~ ' ~ ~ REPORTS F.A. ~BV~S
s This instrument prepared by: ~ ~ ,F.A. NO. OOZO1
aIlI~EY LH~IAR~I F.O. ~d. s~A ~ L. ONlY x O. IN~EBT, x
Department of Labor and Employment Security
~ Caldwell Btchj., Tallahassee, Fla.
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