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r? ~ STATb OF ELORIDA
s r DEPART~[ENT OF HEALTH AND REHABILITATIVE SERV[CES
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P ~s L _ ~~"~'ppUGLAS T'IYON
,,.t~ 8~. Nt,T1CE of LiEN
~k Q~ (;p~ Client vumber 09-45112-02
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'7~~ S $r ~ Lien Number 9-1051
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Pursuant to the provisions of Section 402.33(8) (a), Florida Statutes, notice is hereby given that there ha~~e been assessed,
; ursuant to provisions of said law. against Donna Tho~ss
2416 Nort6 21st Street
Ft Pierce, Florida 34950 -
fiability for payment of fees to the Florida Department of Health and Rehabilitative Services, pucsuant to che provisions of said
law, the sum of S 147 .00 unpaid fees, which after demand for payment thereof remain unpaid, and that by virtue of the ~
,F~,ve mentioned law the amount of said fee, constitutes a lien in favor of State of Florida Department of Hralth and Rehabilitative
S~n~ices upon any title or interest, whether le~al or equitable, in any real property, chattels real, or penonal property of said client
urresponsihleparty. Section 402.33($)(b), F~orida Statutes.
Periods for which fets have been assessed, and the amounts theteof, ue as foUows:
Chauncey McCrarp (client)
'i 4donth/Year Fee Assessed Month/Year Fee Assessed
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~ Juvenile Court
Case #89-1326 ~~1 23 P ~ ~
i020817 BK
~ August 1989 135.00 ,r ~~i~ • • ~`y'~
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Plus Accnied interest
Recordin Fees 12.00
Tota! S 147.00 S
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This 19ttbaY of January . ~.o. t9 90 STATS OF FIQRIDA D~Ai~ OF I~AG1H
' A[~ S'BRVICES
This instrumsnt prepersd by:
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E Sherri Capps, P~a'al~eg~l. Speciali-st .
~ Dapart~ent of H'alth b Rehabilitatfvo Services ~ Authorizb Otticial
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s 111 Georgia Avenu•
~ 'rtesc Pala Beach. Floride 33401-5298
~ d07/837-5087 - SunCo~ 252-3087 ~y~jk~~ a
tt~ ~ My Commi~~ort IExpltis
~ S,rorn to and Subscribed b~tore ~ this ~q tlay ot ~,~Dl.r) A.O.. 19 ONObN2~.
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i Sntotk Nuer+6pN• A 3740-000~•1~~ OdrtlOn/) 80~ r~C~~
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