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STATE OF FLORIDA
L~S FOF#M UCT t8 DEPAR'TMENT OF LABOR AND EMPLOYMENT SECURITY ~u 1~'sed
(REV. 9/84) DIVISION OF UNEMPLOYMENT COMPENSATION „
BuR~?u oF ~?x ~'49831 ~
171LLAHA3SEE, FLORIDA 32301
TEL 904/488-7621
NOTICE OF TAX LIEN
Em~loyer:
K~ T K I TGHEN 5 I NC ~ Account Number ~ O 1 0612
3229 GLEANDER ELVO C-12
FT PIERCE FL 33450 Lien rh:mber 6-04605
Pursuant to the prov+sions of Secti~xi 443.141(3) (a) and (g) Florida Statutes, known as the lien provisions of the F{orida Unemp{oyment
C.orr~pensation Law, notice is hereby giv~en that the abov~e named employer is liable for the payment of c~ntributions to the Unemployment
Compensation Fur?d of Florida. Pursuant to the provisior~,s ot said law, the fdiowing contritxrtions, interest, penalties, and fees which a(ter
demand for payment thereof remain unpaid, and that by virtc~e of the above mentioned law, the amount of said contributions (taxes) together
with interest, penatties, and other costs that may accrue in addition thereto, constitute a fien in favor of STATE OF FLORIQA DEPARTMENT
OF LABOR AND EMP~OYMENT SECURffY upon the title to arxi inierest, whether iegal or equitah{e, in any real property, chattels real,
or P~rsonal property of said emp{oyer.
! Periods for which contributions, interest, penalties, and fees have been assessed, and the amounts thereof, are as folbws:
O/YR TX% DUf INiEREST THROtKiH PENALTY SERVICE FlUtdC
DUE FEE FEE
~2/a l /8fJ
; t,~ 3/84 i 1.~1 .68 10.00
' i$ 4 4/84 253.65 15.22 10.00
~ 1 o a iJaS 271.76 12.23 l0. o0
f a.4 2185 227.00 6•81 10.00
~ 1 a 4 3/85 158• 15 2.37 5.00
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~ '74 831
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TOTAL AMOUPIT OF TAX UEN 1. 004. ~8
1h'ITNESS THE OFFICIALR~p '';7~ ;t..~~,
ATE OF FLORIDA DEPARTMENT OF LABOR AND EMPLOYMENT
S~CURITY, DMSION OF U~EW~~~~,~~~81MPENSATION, at Tallahassee, Florida, this l OT H
FEEAUARY 'ad'~ ~L.
_iay of , A.D. 1s
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' ~ ~ ~ AGENCY USE ONLY
r p ~ ~1 REMiTNO. pATE 3/4/86
~oOM PACf
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, ~ No w?v.
; ~ PJrA. pAT~FlLED 3/4/86 tlFll
~ REPORTS FA Bergandi
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TFis mstfument Prepared by. Sed FJ1 NO.
~ SHI RLEY LECNwRO Fo. rro. 2-2A 56 L OPiLY o. ~oEeT.
Department d Labor and Employment Secu:ity
r Caldw~efl Bldp.. Ta(lahassee. Fla. •
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