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STATE OF FLORIDA
LES,FORM UCT 18 DEPARTMENT OF LABOR AND EMPLOYMENT SECURITY
_ ~R~v. DIVISION OF UNEMPLOYMENT COMPENSATION
BUREAU OF TAX~
• ' TALIAHASSEE, FLORIDA 32301
TE L. 904/488-7621
NOTICE QF TAX LIEN ~ P~~1
~ ~ tmp~oyer. flLE:D ~h~l i: ,
~6ER POt; i;.' ~
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S C~~ONMiTERUCTIp,I Account Number 6b894Z LUClE CUUFi+ ~f. F~x
lsl l. AYEMi~ M. Lien Number ~ 5¦-1d66T
~T .P~EACE il . ~SO
~'07'~g2
Pursuant to the provisions of Section 443.141(3) (a) and (g) Florida Statutes, known as the lien provis'sons of the Florida Unem-
ployme~t Compensation Law, notice is hereby given that the above named employer is liable for the payment of cantributions to the
Unemployment Compensation Fund of Florida. Pursuant to the provisions of said faw, the following contributions, interest, penalties,
and 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 adciition thereto, constitute a lien in favor
of STATE OF FLORiDA DEPARTMENT OF LABOR AND EMPLOYMENT SECURITY upon the title to and interest, whether legal
or equitable, in any real property, chattels real, or personal property of said employer.
Periais for which contributions, interest, penalties, and fees have been assessed, and the amounts thereof, are as foilows:
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~ Q/YR TAX DUE INTEREST THROUGH PENALTY SERVICE FILING
~ 051O1/85 ~UE FEE FEE
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TOTAL AMOUNT OF TAX ~IEN )a0•~
WITNESS THE OFFICIAL SEAL OF THE STATE OF FLORIDA DEPARTMENT OF LABOR AND 6TMLOYMENT
~ECURITY, ~VISION OF UNEMPLOYMENT COMPENSATION, at Tallahassee, Florida, this
~+ay of T , A. D. 19 85
, ~ AGENCY USE ONLY
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- REMIT NO. DATE 5~21 5
' i~~ ~ - AMT. S NO PAY.
801~ ~n/V P~GE t~ ~QS • _ P.M. UATE FILED ~ _
REPORTS F.~,. Davis
This instrument prepared by: ,F.A. NO. 00101
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$~=p`~ F.O. NO. Z~4 ~ L. ONLY O. INDEBT. x
Department af Labor and Employment Security
Caldwell Blc.+g., Tallahassee, Fla.
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