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STATE OF FLORIDA
LE~S FO~iM UCT 18 DEPARTMENT OF LABOR AND EMPLOYMENT SECURITY
. ~qEy. DIVISION OF UNEMPLOYMENT COMPENSATtON
BUREAU OF TAX ~Q
i~S ,
TALLAHASSEE, FLORIDA 32301
TE L. 804/488-7621
~ MAY 23 P2 ~7
NOTICE OF TAX LIEN ~
R ILER ~,4~ ~ ~ . ~~7~
~ Employer.
ST. LlJCIE~COL=kT Y~F~K
C~ARTEii CA8IN8TS+ IN~ Account Number ~~7{~
!l9 G#Y~IAQ~! AVE '
FT Pj~RCE. FL 3~+?SO Lien Number 5~Y30iT - .
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Pursuant to the p?ovisions of Section 443.141l3) (a) and (y) Florida Statutes, known as the lien provisions of the Florida Unem-
ployment Compensation ~aw, notice is hereby given tHat the above named employer is liable for the payment of contributions to the
~^zmplnyment Compensation Fund of Florida. Pursuant to the provisions of said law, the following contributions, inter~st, penatties,
and fees which after demand for payment thereof remain unpaid, and that by virtue of the above mentioned faw, the amount of said
contributions (taxes) together with inte~est, penaities, and other costs that may accrus in addition ihereto, constitute a lien,in favor
af STATE OF FLORIDA DEPARTMENT OF LABOR AND EMPLOYMEIVT SECURITY upon the title to and intetest, whethe~ legal
or equitable, in any real property, chattels real, or personal property of said employer.
Peri«fs for which contributions, interest, penalties, and fees have been assessed, and the amounts thereof, are as follows:
Q/YR TAX DUE INTEREST THR(2UGH PEiUAl.7Y SEAVlCE FILING
OE/~Oi/a~S ~UE FEE FEE ~
~ 29~..26 ~ 4.4~ 15•00
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TOTAL AMOUNT OF TAX LIEN _ .~13s87
VJITNESS THE OFFICfAL SEAL OF THE STATE OF FLORIDA DEPARTMENT OF LABOR AND 6TNLOYMENT
SECURITY, (~I~YStON OF UNEMPLOY~ NT COMPENSATION, at Tallahassee, F{orida, this
day of , A.D. 19 _ .
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~ ~ AGENCY USE ON1,Y
- ~ REMIT P10. OATE S~2I~~r]
" t}~
~ AMT. S NO PAY.
BOOX PAC~ ~ n~ p.M. DATE FILEO 2
~`y' • ; t-
REPOATS F.A. DSV~S
7his instrument prepared by: ~ ,F.A. NO. 0~ Q1
~+i~a.eY ~~a+~o z,.~ . ~ '
F.O. NO. L. ONIY O. INDEBT.
Department of Labor and Emptoyment Security
Caldwell 81dg., TallaF~assee, Fta.
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