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STATE OF FLORIDA ~i
LES EORM UCT 18 DEPAR'TMENT OF LABOR AND EMPIOYMENT SECURtTY F~e i g~
~R~v. siaa~ DIViSiON O~ UNEMPLOYMENT COMPENSATION
BUREAU OF TAX
TALL.AHASSEE, FLORIDA 32301
~~~-~sz, ~49832
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NOTICE OF TAX LIEN ;
~ E-n~loyer: ~
StJN ?ECH ~ ADOt,S' I MC Account Number 0680680
2SS7 PRICE CT
PORT ST LUCI E_ fL 33AS2 ~~m~~ 6-10031
Pursuant to the proyisions of Section 443.141(3) (a) and (g) Florida Statutes, known as the lien provisions of the Florida Unemp{oyment
Compensation Law, notice is hereby given that the above named smployer is liab{e fcx the payment of contributions to the Unempbyment
Comper~sation Fund of Floricia. Pursuant to the provisions of said law, the fdlowing contributions, interest, penatties, and fees which after
demand for payment thereof rernain unpaid, and that by virtue of the above mentioned law, the amount of said contributions (taxes) togethe+~
with interest, penalties, arxi other cosis that may accrue in addition theneto, ca~stitute a tien in fawor of STATE OF FLORIDA DEPAR'fMENT
OF LABOR AND EMPLOYMENT SECURtTY upon the title to and intenest, whether fegal or eQuitab{e, in any real property, chattels real, ~
or P~onal ProPe~tY of said ert~loyer.
Periods for which contributions, interest, per~afties, and fees have been assessed, arxi the amounts thereof, are as folbws:
i o~rR ux a~ ~aesr ~+HOUGH ~w?~rr se~ ~ur~+c
I 02/O1/ab ~e ~e
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~as Zs~.24 3•a0 - 1S~A0 ~
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10 A 9 :39
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FILE ~',t,;
ROGE PC~I : C~~; ,qK
S~ L!F i;OuN? Y, F~.
TOTAL AMOiJNT OF TAX LtEN 272~ 04
VVITNESS THE OFFlCIAL SEAL OF THE STATE OF FLORIDA DEFARTMENT OF LABOR AND EMPLOYMENT
~~.CUAITY, DIVISlON OF UNEMPLOYMENT COMPENSATION, at Tallahassee, Florida, this iTTM
FE~!/iRY ~6
~!a~,~ of , A.D. 19 .
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OQIt PAGE ~,'1 , _
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~ ' ~ PAA. OATE F~ED 3 ~ `t ~ v ~F t
5~ r'iEPORTS FA Be r 8T1C~ ~
rh+s ir~trument prepared by. ~ sed ~ FA No. Q O I
Rt~SSELL CGAiASON F.o. ra. ~-2A 4~ ~ or~Y o. ~ar. x
Oepartment af Labor and Empbyment Security
Caldw~.~l! 8idg.. Tallahassee. Fla .
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