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: STATE OF FLORIDA
DEPART1tEvT OF HEALTN AND REHABILI'iAT[VE SERV[CES t
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°y` r.`~-`"` .~T.~~ON NOTICE of LIEN
_ - "~'Y Client Vumt~er 09-45118-42
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i''-•;p ~;2 C..-_~.. C'ourt
, , ~ 9-1075
I;: ~ . : - `r'y Lien ~Iumber
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Pursuant to the provisions of Section 402.33(8) (a), Florida Statutes, notice is hereby given that there have been assessed, j
I ursuant to provisions of said law, against Cind~ Harrold ;
681 Riv Vista Drive
Ft. Pierce,.F~orida 34982
liability for payment of fees to the Florida Department of Health and Rehabilitative Services. punuint to thz prov,s~ons of iaid i I
iaw, the sum of S 312 .00 unpaid fees, which after demand for payment thereof remain unpaid, and that by virtue of the
.~bove mentioned law the amount of said fee, constitutes a lien in favor of State of Fiorida Departmrnt of Haalth ~nd Rehabilica~ive j
S~rvices upon any titt~ or interest. whether legai or equitabie, in any rea! propeRy, chsttets real, or penonal property of said client
or responsible party. SectiOC1 402. 33( 8)( b) , FlOrida Stetutes.
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Periods for which fees have been assessed, and the amounts thereof, ue as follows:
C6ad R. lioore (client)
1~tonth/Year Fee Assessed Month/Ye~r Fre Assessed
'90 ,1~W 24 P 1 :05
Juvenile Division 1~'LiQSS gN
Case /89-1034
r 1L~ C~ A!i~l RE C;_~;:
~OUGI AS JiX+Jli : ~
i Jul~ 1989 300.00 S1 LUC;tE t-~~JNi '
Plus Accnied interest
Recordin Fees 12.00
Tocal S 312.00 S
T n i s 19 t 4jay of Ja n u a r y , ~.0. t 9 90 STATE OF P~A DE~PAKDr~ OF I~'AL.'II~1
A~D S~VI(~5
7his instru~ns~t prspared by:
Sherri Ca~is. P~~ale~l Special.ist -
Departn~ent ot Health d Rehabilitativ~ Services Authorizea Offic al
~11 Geor~ia Av~nus ~D
~ast pala~ Beach. Florida 33401-5298
a07/837-S487 - SunCoai 252-3087 Notar Stst•
. = Nptary Pu6f1c Staa ol F1or1d~
n ~ ~Ay ~ComrMislon Exp1tM
Srorn to and Subscribad b~tore N this''1~GeY ot C~/Yl A.O.. 19~~. ~~i,~ p~~p~, tp~
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~Stock Nvmb~~~ S7ap-OpO~p'540-11
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