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STATE OF FLORIOA
S.ES FORM UCT 18 DEPARTMENT O~ LABOR AND EMPLOYMENT SECURITY
tfiEV.9/88) DIVISION OF UNEMPLOYMENT COMPENSATION
BUREAU OF TAX
TALLAHA8SEE, FLORIDA 32398~0218
8521'~ 1 ~ T~ so.~4s8.»,
N~~'ICE OF TAX LIEN
Employer: .
~~a=i~ Account Number9T0.~185
5741 BRIARGA7E lM
FT PIERGE FL 33~~ lien Number 7-245b0
Pursuant to the provisions of Section 443.141 i3) ls) and (g) Florida Statutes, known as the lien provisions of the Ftorida Unem- '
; ployment Compensation Law, notice is hereby given that the above named employer is liable tor the psyment of oontributiQns to the
, Unemployment Compens~tion Fund of Florida. Pursuant to the provisions of said law, the following oontributions, +nterest, penalties,
and fees which aher demand for payme~t thereoF ~em~in unpaid, and that by ~irtue of the above menti~nad taw, the smount of said
cont?ibutions (taxes) together with interest, ~senalties, and other oot~s that n~ay. acixue in sddition thereto, oor~stitute a lien in fsvor
of STATE OF FLORIDA DEPARTMENT OF LABOR ANO EMPLOYMENT'S~CURITY upon the title to and interest, whether legai
or equiWble, in a~y real property, chattels real, or personal property;of said employer.
Periods for which contributions, interest, penalties. and fees hsve been assessed, and the amounis thereof, srs u follows:
0/YR TAX DUE INTEREST THROUON ?EMA~TV 8ERVICE FILINO
~ OUE FEE FEE
a9/ouaz
. 1~4 8T 5~208.O~r 104•16 ' 10~00.
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TOTAL AMOUMT OF TAX LIEN 5~32~2~
WITNESS THE OFFICIAI SEAL OF THE STATE OF FLORIDA DEPARTMENT OF LABOR AND EMPLOYMENT
SECURITY, OIVISION OF UNEMPLOYMENT COMPENSATION, at Tallshassee, Florida, this $jH
day of S~P~El~3ER , A.O. 19 $7
d,~ ~ooK 5~ ~ 945
AGENCY t1fE ONLY
REMIT NO. DATE
~ ~ AMT. = NO PAY.
P.M. DATE FILE~ F
- REPORTS F,q, B@I andi
This instrument prepared by: g~ ~ F~ fl
QIiCS~= l CLIt/RS[]Y F.O. ti0. 2'~~w 56 ONLY O. INDEB7': x
Oepxtmertt of L~bor and Employment Secu~ity '
Caldwell 81dg., Tsllahsssea. Fls.
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