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STATE OF FLORIDA ~
LES FORM UCT 18 DEPARTMENT OF LABOR AND EMPl.OYMENT S~C!iRiTY
(REV.9184) DIVISION UF UIdE!!IlPL.OYMENT COMPENSATION
BUREAU OF TAX
TAl.LAHASSEE, FLORIDA 32301
TE L. 90d/d86-7621
NOTICE QF TAX LIEN P2~
Employer. fILEO ~ U
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~ OA1tI0- E CwRTEA .tW Account Number 67~`UGE~COGN;'~. F~K
6L1~:° MAT~J4 •OOI.~ii i
~AIT OL~EAMpEti AYE Lien Number l~1T~00
- ~r ~t~c~. F~., aa~6o ,70,7,~~4
Pursuant to the provis~ons of Section 443.14113) (a) and (y) Florida Statutes, known as the lien provisions of the Florida Unem-
' ployment Compensat~on Law, notice is hereby given that tfie above named employer is tiable for the payment of contributions to the
Unemployment Compensation Fund of Florida. Pursuant to the provisions of 4aid law, the following contributions, interest, penalties,
and fees .rrhich after demand for payment thereof remain unpaid, and that by virtue of the above mentioned law, the amount of said
contributions (taxes't togethe~~ with interest, penalties, and other costs that may accrue in add'+tion thereto, consiitute a lien in favor
of STATE OF FLORIDA DEPARTMENT OF LABOR AND EMPLOYMENT SECURITY upon the title to and interest, whether legat
or e4uitable, in any real,property, chattels real, or personal property of said employer.
Peri«is for which contribut~ons, interest, p~nalties, anti fees have been assessed, and the amounts thereof, are as foUows:
I QfVR TAX DUE INTEREST THROUGH PENALTY SERVICE FILING
' OSIOI/OQ OUE FEE FEE
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w'%~ 5.~0
~ d!!8+- 86•47 1s30 ~ 1S•00 -
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TOTAL AMOUPlT OF TAX LIEN - la7•~~
~ WITNESS THE OFFICIAL SEAL OF THE STATE OF FLORIDA DEPARTMENT OF LABOR AND 6TM~OYNIENT
~ SECURITY, [~IVISION OF UNEMPLOYM~NT COMPENSATION, at Tallahassee, Florida, this
~ day of Y , A.D. 19 -
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~ ~ ` AGENCY USE ONLY
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; - REMIT NO. OATE ~~2~~~~~_
~ODK ~V~ P~if ~7 ~ AMT. S NO ~AY_
~y'i.'~~ P.M. DATEFI~ED 7 ~i
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REPORTS F.A. Davis
This instrument prepared by: ~ ~ * ,F.A. N~. 01
~11lf~tt.ET. LBOMAAD F.O. NO. 86 L. ONIY O. INOEBT.
Departme~t of Labor and Etnployment Security
Caldwell Bldg., Tallahassee, Fla.
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