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STATE OF FLORIDA
~ LES FORM UCT 18 DEPARTMENT OF LABOR AND E14~NlOYMENT S~CURITY
~REy, 9?s~~ ~IVISlON OF UNEMPLOYMENT COMPENSATION
BUREAU OF TAX
TAI.IAHASSEE, FLORIDA 32301 ~(~7R7
~ V i ~R~i
TE L.. 904/d88-7621
MAY 23 P2 ~7
NOTICE OF' TAX LIEN ~
Fi~Ee a~~
Empioyer. RQGER P01 ~ n.- .~(~=~K
F~•:oilyiCE FOAI( LIFT SER11ItE5 Account Number slYpga WCIE C0~1;; Y. FL.
INC
~ 109.~ A~ NORfM ~97H- 8TREET ~ ~ien Number li~+~,34?O
FT P iER~E FL ~34s0
- '7tY7281 - .
Pursuant to the provisions of Section 443.141(3) (a) and (y) Florida Statutes, known as the lien provisions of the Florida U~em-
ployment Compensat~on Law, notice is hereby given that the above named empl.oyer is liable for the payment of contrilwtions to the
Unemploy~~~ent Compensation Fund of Florida. Pursuant to the provisions of said law, the following contributions, interest, penatties,
and fees which after demand for paymer?t thereof remain unpaid, and that by virtue of the apove mentioned law, the amount af said
coniributions (taxes} together with mterest, penalties, and other costs that may accrue in addition thereto, conititute a lien in favor
of STATE OF FLORIDA DEPARTMENT OF LABOR AND EMPLOYMENT SECURITY upon the title to and interest, whether legal I
~r equitable, in any reai property, chattels real, or personal property of said employer.
Perials for which contribut~ons, interest, penalties, and fees have been assessed, and the amounts thereof, are as follows:
Q/VR TAX DUE IN7EREST THROUGH PENALTY SERVICE FILING
~ OUE FEE FEE
oa.?oiie6
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~ , ie~?, ao.ao .7a - ~ i s.oo _
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~ TOTAL AMOUNT OF TAX UEN ?Q~?S
byITNESS THE OFFICIAL SEAL OF THE STATE OF FIORIDA DEPARTMENT OF LABOR AND 6TMLOYMENT
SECURITY, ~IVlSION OF UNEMPLOYMENT COMPENSATION, at Tallahassee, Florida, this
day of AY , A.D. 19
.~s`,e ~
~ AGENCY US~ ONLY
REMITNO. OA7E 5~ 2~./ 5
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~ AMT. S NO PAY.
SO'0~~~ PAGE t R~ ~s F,~~ P.M. DATE FILED _~~21~ S
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FiEPORTS F.A. Davis
This instrument prepared by: ~ ~ ~ ,F.A. NO. OOZ~Z
SMZaLE~ LEW'IARO F.O. NO. ~~A ~ ONIV x O. fNDEBt.x
Department of Labor and Employment Security
Caldwell Bldg., Tallahassee, Fta.
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