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: STATE OF FLORIDA
~ r DEP~RT~tEYT OF HE.~ILTH ~ND REHaBtLITATiVE SERVICES
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R~rcef ~-~TTri_A~r~~~NN07'-ICE of LIEN o9-4s~2z-o2
F'ee S:. Lu~: • Client Vumber
DOC Tg~ s (`l••T~ nf C.::::.: !~,•..I7~ 9-1059
Lien ~umbet
Int Tax t 3y
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• Totsl i ._JG~~~
Pursuant to the provisions of Section 402.33(8) (a). Florida Statutes, notice is hereby given that there have been zssessed,
~ unuant to provisions uf said law, against LOretts Bo11ie
• 3103 A~enue F
Ft. Pierce, Flarida 34950
tiability for payment of fees to the Ftorida Depattment of Health and Rehabilitati~e Sorvices, pursu~nt to the provis~o~s of iaid
law, the sum of S 357.00 unpaid fees, which after demand for payment thtrtof remain unpaid. and that bv virtue of the
~bove mentioned law the amount of said fee, constitutes a lien in favor of State of Florida Department of Health and Rehabilitative
Srrvices upon any title or interest, whether le~aal or equitable, in any real property, chattels rcal, or penonal property of said ~lient
or responsible party. Section 402. 33( 8)( b) , Florida Statutes.
Periods [or which fees have been assessed, and the amounts thercof, ue ;~s follows:
i Stephan A. Lifhred (client)
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~ 1~tonth/Year Fee Assessed Month/Ye~t Fee Asxsxd
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f 1021053
' Juvenile Di~ision
~ •~o 2a P ~ :05
; Case 89-1306 Pjh
Septe~ber 1989 345.00 ~~~E` ~~~'~U ~`~t
i DOUGIA~ GdXON .
~ S1. LUCi~ ~.~1!:N i ~
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~ Plus Accnied interest
~ Recordin Fees 12.00
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~ Total S 357.00 ~
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znis 19thdaY os Janusr~ . ~.D. ~9 90 STA'tE OF FLOR~ DF•PAIal~ OF E~A[,~i
AI~ St~VI~S
Tris instruiaent prepersd by:
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Shem Cappsf ''.`..-'e~l :ipecialis't
~ Department ot Healtn b Rehabilitative Services Autho~ized Otticial
~ t1~ Georgia Avenu• o
~ ~lest Pal• 8each. Florida 33401-5298
~ a07/857-5087 - SunGfla 252-5087 c- S~B~ w~
~ ~y p~,p11c gtst~ d
~ Sworn to and Subscribed botore ~s this `~f-`
bay ot E~v A.O.. 1~. ~gp
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hIRB Fo.~n 540. Ma q iOro~at p.r+nour ~d~tionsl ~ A ~ i~~~7i~
~StOtk NumD~r' ST40-0'DO-OU0•11 600~
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