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STATE OF FLORIDA
LES FORM UCT 18 DEPARTMENT OF LABOR AND EMPLOYMENT SECURITY
IREV.91861 DIVISION OF UNEMP~OYMENT COMPENSATION
BUREAU OF TAX
TALLANASSEE, FLORIDA 32399-0218
TE L. 904/4?88-7621
1020497
NOTICE OF TAX LIEN
~ E mpioyer.
FR~O t~iUDSHAM Account Number 1179332
SUIitISE EX?EftIORS
1504 ttOLYA? ST lien Number 9--27669
fT PItKGt Fi. 349ti7
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Pursuant to the provisions of $ection 443.141(3) (a) and (y) Florida Statutes, known as the lien provisions of the Florida Unem•
ployment Compe~sat~on Law, notice is hereby given that the above named employer is liable for the payment of contributions to the
Unemployment Compensation Fund of Flor~da. Pursuant to the provisions of said law, the following contributions, interest, penalties,
and fees which after demand for payment thereof remain unpaid, and that by v~rtue of the above mentioned iaw, the amount of sai~i
'i contributions (taxes} together with ~nterest, penalties, and other costs that may accrue in addition thereto, constitute a iien in favor
of STATE OF FLORIDA DEPARTMENT OF LABOR AND EMP~OYMENT SECURITY upon the title to and interest, whether legal
or equitable, in any real property, chattels real, or personal property of said employer.
Perials tor wh~ch contribut~ons, interest, penalties, and fees have been assessed, and the amounts thereof, are as follows:
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I Q/YR TAX OUE INTEREST THROUGH PENALTY SERVICE FILING
~ ~UE FEE FEE
~ 12/0 l,/ 89
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1/ ~9 s• °O ~0 J 22 P 2:5 ~
1. a 4 ~ 2/ 89 2 b. 2~i .26 15~ 00
; ~p3 ~ 21d9 2.26
! ~ s4 I 3/ d9 211. d2 l.ab 5.00 t,~; i' .
6 i ~OUGi a ; x~N
~ ~ ~C - ~ DIRON Sl i.t?~ ~ ~~';~J'. •
! ~ . F~ e ~ DGUG
t ' ~u r•~ s__ s~ c~~t,? 1 2 0 4 9?
~ I Clerk af G~r~uit Comr!
~ ~ ~ ~i j5 gY
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Toc~i $
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$
TOTAL AMOUNT OF TAX LIEN 26b.64
WiTNESS THE OFFfCIAL SEAL OF THE STATE OF FLORIDA DEPARTMENT OF LABOR AND EIIIIpLOYMENT
SECURITY, DIVISION OF UNEMPLOYMENT COMPENSATION, at Tallahassee, Florida, this ~~t;
c+ay of ~GE~~ , A.O. 19 d9 ~407)465-56ti2
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AGENCY USE ONIY
REMIT NO. OATE Z-1$-9O
~ g~ ~ AMT. S NO VAY.
' P.M. DATE FILED ~~F~~
! ~S r REPORTS F.A. A. BerQar.di
This instrument prepared by: ~ ~ ~ F.A. NO.
R1lSSE1 ! Gf]IIRS[lill F.O. NO. ~~ZA 56 l. ONIY x O. INDEBT. x
Departmertt of Labor and Employment Security
Caldwell Bldg., Tallahassee, f;o. e~~~] ~
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