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STATE OF FLORIDA
LES FORM"UCT 18 DEPARTMENT OF LABOR ANQ EMPLOYMENT SECURtTY
• (REV.9/84) DIViS10N OF UNEMPIOYMENT COMPENSATION
BUR~AU OF TAX
TALLAHASSEE, FLORIDA 32301 ~+1~1?yr~tyL
~V ~Fr~v
TE L. 804/488-7621
NOTICE OF 'T'AX LIEN ~ ~ ~ P2~7
~ EmP~oyer. F1 EO AR"'
CNAl~EA= F~GAPORATIt~N Account Number p~R P~t:+ ~..L~RK
~~6 LUCIE CU~ h ~ 'f. F~.
P~ 8G7I• i~b
FT PIEACE FL a3480 Lien Number 5--1st06~
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Pursuant to the prov~sions of Section 443.141(3) (a) and (y) Florida Statutes, known as the lien provisions of the Florida Unem-
ployment Compensat~on Law, notice is hereby given that the above named employer is liable for the payment of contributions to the
Unempfoyment Compensation Fund of Florida. Pursuant to the provisions of said law, the following contributions, interest, penalties,
ar.d fees which 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 addition thereto, constitute a lien in favor
of STATE OF FLORIDA DEPARTMENT OF LAB~R AND EMPLOYMENT SECURITY ~pon the title to and interest, whether legal
or eyuitable, in any real property, chattels real, or personal property of said employer.
Periais for which contributions, ~nters;t, p-~nalties, and fees have been assessed, and the amaunts thereof, are as follows:
Q/YR TAX OUE INTEREST THROUGN RENALTY SERVICE FIIING
f oa?~ ~ea OUE FEE FEE
G. -
4
s +b /8+ S0.a0 •7S ' 15.00 ~
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TOTAL AMOUNT OF TAX LIEN bs~T~
WITNESS THE OFFICIAL SEAL OF THE STATE OF FLORIDA DEPARTMENT OF LABOR AND 6TMLOYMEf~tT
SECURiT1', ~V~SION OF UNEMPLOYM~ENT COMPENSATION, at Tailahassee, Fl~rida, this
;fay of , A.D. 19~.
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V ~ AOENCY U8E ONLY
t~ REMIT NO. DA7E ~/2~~$5
~ ~ ~ AMT. S NG PAY_ ~
BOOX ~~E P.M. ' OATE FILEU S 21'1 v7
- REPOH7S F.A. DAVj.B
This instrument prepared by: ~ ~ ~ ,F.A. NO. ~0].~1
.
SIIII~LEY ~~OMwRO F.O. NO. s~~ ' ~ L. ONLY O. INDE@T.x
Qepartment of Labor and Employment Security .
Caldwell Bldg., Tallahassee, Fla.
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