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STATE t7F FLORIDA
- OEPARTMENT OF LABOR AND ci
~°~OYME~i11T SECURITY
LES FORM t;:.: te DIV1SiON OF UNEMPLOYMENT COMPENSATION
{~ev. gUR~AU OF TAX
TALLAHASSEE, FLORIDA 32301
TE L. 904/488J621 ~~2 ~ ~7
NOTICE OF' TAX LIEN P2~7 ~
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Employer:
~EGOi~ CABiME~RY ~ t IMSTII~.L ~ Account Number ~O2gZ6~R P01 i~;r'.; . ~it .
POitT ST . LtKIE IMt LUCiE COl1N i v, r t. .
- t06a MOLYi~OOK- C01iRT 6AY ib Lien Number 5-1~849
- 35Q~ S~- L110MER" LTREET r~t
• PART aT L11GlE RL. 33+?5~
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Pursuant to the provisions of Seciion 443.141(3) (a} and (y) Florida Statutes, known as the lien provisions of the Florida Unem- I
ployment Compensation Law, notice is hereby g+ven that the above named employer is liable for the payment of contributioni to the
Unemployment Compensation Furxi of Florida. Pursuant to the provisions of said law, the following contributions, inierest, penalties,
and fees which after demand for payment thereoi 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 LABOR AI11D EMPLOYMENT SECURITY upon the title to and interest, whether legal
or equitabie, in any real property, chattrls real, or personal property of said employer.
t Periais for which contributions, interest, penalties, and fees have been assessed, and the amounts thereof, are as follows:
~ Q,~YR TAX DUE INTEREST THROUGH PENALTY SERVICE FIIING
~ O~/Q1~8s DUE FEE FEE
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~ ~a Ii84 T8•T3 1.l8. • 15.00
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TOTAI AMOUNT OF TAX LlEN 44~91
~ VVITNESS ~HE QFFICIAL SEAL OF THE STATE OF FLORIDA DEPARTMENT OF LABOR AND ~jMLOYMENT
~ SECURITY, [~IVISION OF UNEMPLOYMENT COMPENSATION, at Tallahassee, Florida, this
- day of ~ , A.D. 19 8~
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~ i~- AGENCY USE ONLY
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REMIT NO. UATE 5/21/85
' (~K~~ ~ AMT. S ' NOPAY.
gOIM P~E VV:v • t.~~~ p.M, OATE FILEO aV S
- REPORTS F.R.
Th?s instrument prepared by: ~ ~ ~ ,F.A. NO.
E~~~~ `~~~D F.O. NO: ~ L. ONLY O. INDE81.~
Department of Labor and Erriployment Security
Caldwell Bldg., Tallahassee, Fla.
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