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10210 51
: STATE OF FLORIDA
s r DEP~RT`tENT OF HE~LTH AND REH,~B[LITATIVE SERVICES
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R~ C~e ncvc~s ~rxox N OT 1 C E of L 1 E N
~ c__ S:. Luric Cou~'y Ciient Vumber 09-45120-02
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U ~ Rl Lien vumber
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Pursuant to the provisions of Section 402.33(8) (a). Florida St~tutes, notice is hereby given that there have been sssrssed,
^ursuant to provisions uf said law, against Ollie Peters
113 Gotha¦ Dri~e
Ft. Pierce, Florida 34950
:iabiliry for payment of fees to the Florida Department of Health and Rehabilitati~e Services, punuant to the provisions ot sa?d
;~w, the sum of S 312.00 unpaid fees, which after demand for payment thereof remain unpaid, and that by vittue of the
lbove mentioned law the amount of said fee, constitutes a lien in favor of State of Florida Departmcnt of Health ~nd Rehabilitative
S~r~ices upon any title or interest, whether legal or equitable, in any rea! propetty, chattels real, or personal property of said ~li~nt
,~r responsible party. SP_Ctlo[1 402.33( 8)( b) , Florida Statutes.
Periods for which fees have been assessed, and the amounts thereof. ere ss follows:
Colandro Peters (client)
~tonth/Year Fee Assessed 'A~oqt~lYear Fee Assesxd
Juvenile Division 1021051
~ ~~o ,~u, 2a P ~ :oa ~
~ Case #89-1008 g~
i FILE~ Ak~ 'tE ;:.~+i+
' i Se te~ber 1989 300.00 OUGIAS [~~XUh
i i p 1. LU~~t~ ':~:;Ni t. .
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~ Plus Accrued interest
Recordin Fees 12.00
~ Tutal S 312.00 ~
~ r n i s 19 t t~aY of Ja n u a r y o. t 9 90 STAZE OF Pi4[tIDA DEFAKII~ OF ~AL~1
u A[~D S~t1/ICF~S
~ ~his instrun~ent preparad t+y:
,
~ Sherri Capps, P`a~ale~l Specialist ' ~
Departinent ot N9alth b Rehabilitativs Services Authorizsd Otticial
~ til Georgia Avenus ~ ~
~ i~est Palm Beach. Fiorida 33401-5298
s07;837-5087 - SunCo~ ?S2-S087 N~t • Stat~{
~ ~ : Nptary PuDtk 3t~ d FbrMa
5korn to and Subscribed bstors n~s this ~~~ay ot Q.r1A.D.. 19~. ~~~M~~~~
OCtobM 20. tlllC!
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~ ~AS fa~ p 8~674 r~i7~.
Stotk NumbN' 57~0-000-0540•11
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