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~ STATE OF FLORIDA
LES FORM UCT 18 DEPARTMENT OF LABOR AND EMPLOYMENT SECJRITY i
~R~.~~ DIVISION OF UNEMPLOYMENT COMPENSATION
BUREAU OF TAX
TALIAHA~SEE, FIORIDA 32301 ~~28~
TE L. 904/488•7621
NOTICE OF TAX LIEN P2~?
Employer: FILEI~ L,?:'~ a
ER f
C~ I i:~~ r~. r;~ K
P R l 1 0 D E I S L A N
D 8 0 L T i~ S
t A E l l l G
D Account Number ~j~3~ ~ ~ U C I E L' O U : i Y F~.
I MC
PETEp FiiA1i1C Lien Number 5-I~09~
2 FAYNONT J?VE
6ARRINCTON R~ OZ806 rJ~r~~p~ r
< <I6C7J
Pursuant to the provisions of $ection 443.141(3) (a) and (g) Florida Statutes, known as the lien provisions of the Florida Unem- -
ployment Compensation Law, notice is hereby given that the above named employer is liable for the payment of cont~ibutions 1o the
Unemployment Compensation Furx! of Florida. Pursuant to the provisions of said law, the following contributions, interest, penaliies,
and fees ~vhich after demand for payment thereof remain- unpaid, and that by virtue of the above mentioned law, the amount of said
contributions (taxesl together with interest, penalties, and other costz that may accrue in addition thereto, con~titute a lien in favo~
of STATE OF FLORIDA DEPARTMENT OF LABOR AND EMPLOYMENT SECURITY upon the titte to and interest. r~hether legal
or equitable, in any reat property, chattels real, or personal property of said employer.
Perials 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 FILING
dUE FEE FEE
osieiias
14/84 A SO• 00 ~•75 • ls•00
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~ TOTAL AMOUNT OF TAX LIEN b~•75
+NITNESS THE OFFICtAL SEAL OF THE STATE OF FLORIDA DEPARTMENT OF LABOR AND 6TMLOYMENT
SECURITY, ~VYSION OF UNEMPLOY~M~ENT COMPENSATION, at Tallahassee, Florida, this
c;ay of . A.D. 19
d ~c~
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` AGENCY USE ONLY
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REMIT NO. DATE 5~~ 5
BO~DK ~ P~ ~ Q - ~ AMT. S NO PAY.
~ y ~ P.M. OATE FILEO S ~
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- FEPOHTS F,A. ba.Vj.S
This instrument prepared by: ~ ~ F.A. NO. 00101
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BMIRLEY L~ONARO F.O. NO. p j ~~d L. ONLY O. INDEBT.x
Oepartment of Labor and Employment Security '
Caldwell Bldg., Tallahassee, F1a.
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