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STATE OF FLORIDA
LES FORM UCT 18 DEPARTMENT OF LABOR AND EMPLOYMENT SECURITY ;
(REV.9/~4) DIVISION OF UNEMPLOYMENT COMPENSATION ~
~ BUREAU OF TAX w~O?7~
TALLAHASSEE, FLORIDA 32301
TE L. 904/488•7621
NOTIGE OF TAX LIEN P2~7 0
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Employer. FILEO f ...`,i
C~VELAMO. Pfi7AOLEtJM ECt1IPME1~1T Account Number bls3 ~ER POi- ~K
GO~ INC ~ LUCIE GQIH~ Y. F~.
• 1T03: TORTEN A~ Lien Number S~1S17T
~T~ PIERCE ~L 33~s4 ~I~z~
Pursuant to the provis~ons of Section 443.141(31 (a) and (y) Flarida 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
lJnemployment Compensation Fund of Florida. Pursuant to the provisions of said law, the following contributions, interest, penaltiss, ;
and faes which after demand for payment thereaf remain unpaid, and that by virtue of the above mentioned (aw, the amount of sa+d ~
contributions (taxesi ~o9ether with interest, penalties, and other costs that may accrue in addition thereto, constitute a lien in favor °
of STATE OF FLORIDA DEPARTMENT OF LABOR AND EMPLOYMENT SECURITY upon the titte to and interest, whether iegal
or equitable, in any real property, chattels real, or personal property of said employer.
Perials for which contributions, interest, penalties, a~d fees have been assessed, and the amounts thereof, sre as follows.
Q/YR TAX DUE INTEREST THROUGH PENALTY SERVICE FILING
I O~p~B~ DUE FEE FEE
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ja~ ~4 84.37 • i.tt7 > is.o0
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~ TOTAL AMOUNT OF TAX LIEN ";OQ+~
'vVtTNESS THE OFFICIAL SEAL OF THE STATE OF FLORIDA DEPARTMENT OF LABOR AND ~TNLOYMENT
:~ECURITY, ~VYSION OF UNEMPLOYeSENT COMPENSATIQN, at Tallahassee, Florida, this E
~?ay of , A.D. 19
d ~'F
' AGENCY USE ONLY
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REMIT NO. DATE ~
{l~ ,~1~ g n~ AMT. S - NO PAY.
~pi~av~ P~GE ~ ~ ' . P.M. DATE FILEO 1
y ~ REPORTS F.A. D3V~S
This instrument prepared by: ~ ~t ~ ~ ,F.A. NO. OQZGZ
~j~~Y F.O. NO. ~$A 56 L. ONLY x O. INDEBT.
Departrr~ent of Labor arxi Employment Security ~
Galdwetl Bldg., Tallahassee, Fla.
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