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STATE OF FIORiDA
lES FORM UCT 18 DEPARTMENT OF LA60R AND EMPLOYMENT SECURITY
(REV.9/861 DIVISION OF UNEMPLOYMENT COMPENSATI~N
~ BUREAU OF TAX
TALLAHASS~E. FLORIDA 32399-0218
TEL. 904/488•7621
iozo~ss
NOTiCE OF TAX LIEN
S Empioyer.
J1IAPdiT GOMIECYION S~~?TTLE I1~ Account Number 1199~52 ±
14 30 dERNAR00 TERR ~
PORT ST IUGIE FL 34952 lien Number 9-26816
Pursuant ta the prov~s?ons of 5ection 443.141(3) (a) and i9) Florida Statutes, known as the lien provisions of the Fforida Unem-
ployment Campensat~on ~aw, notice is hereby given tt~at the above nameci emptoyer is liable for ihe payment of contributions to the
Unemployme~t Compensation Fund of Florida. Pursuant to the provisions of said law, the following contributions, interest, penaities,
and fees which after demand for payment thereof remain unpaid, and that by virtue of the above mentioned law, the amount ot said
contributions {taxes) together with interest, penalties, and other costs that may accrue in addition thereto; oorutitute a lien in favor
of STATE OF FLORIDA DEPARTMENT OF LABOR AND EMPIOYMENT SECURITY upon the title to and interest, whether legal
or equitable, in any real property, chattels rea{, or personal property of said employer.
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~ Perials for which contribut~ons, interest, penalties, and fees have been assessed, and the amounts the~eof, are as fotlaws: ~
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~ Q/Yq TAX DUE INTEHEST THROUGH VENALTY SERVICE FiLING '
~ i1jO~N DUE FEE FEE ~
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2/ 89 28 2.03 4.2 2 15.0~ ~AN ~ P 2~^ l,
. ~ ( 3/ gq 213.65 . , - N
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~ I~.~ DOU(3LAS D27~ N S l i; i~~~ l)N ! r.
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' 70TAL AMOUNT OF TAX LIEN 513.90
1NITNESS THE OFFICIAL SEAL OF THE STATE OF FLORIDA DEPARTMENT OF LABOR AND13~~ pYMENT
SECURITY, DIVISION OF UNEMPLOYMENT COMPENSATION, at Tallahassee, Florida, this
day of t~3VE1~ER , A.D. 19 89 t~07~335--97?7
AGEMCY USEONLY
~ REMIT NO. DATE 1-1S-9O
AMT. S NO PAY.
~ ~ ~ P.M. OATE FI~EO ~F
; s ~ REPORTS F.A. D. Bergandi
' F.A. NO. 00154
Th~s instrument prepered by: ~y
RL~SS~I L CA~SnL F.O. NO. Z~ZA 56 L. ONLY x O. INOEBT. x
Departmertt of Labor and Emptoyment Secur~ty
Caldwell Bldg., Tallahaasee, Fla. Q
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