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IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
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CERTIFIED COPY OF LIEN
TO THE PROTHONOTARY OF SAID COURT:
Pursuant to Section 308.1 of the
Pennsylvania Unemployment
Compensation Law, 43 P .S. !i 788.1,
. this is a Certified Copy of LiEln for
unpaid unemployment compensation
contributions, interest and penalties to
be entered of record by you and
indexed as judgments are indexed.
PENNSYLVANIA EMPLOYER
ACCOUNT NUMBER: 21-18777 1
AD Number:
286142
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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF LABOR AND INDUSTRY
TO THE USE OF THE
UNEMPLOYMENT COMPENSATION FUND
.
vs.
JOHN ALLEN OSBORN II
INDIVIDUALLY & T/A
OSBORN'S FOOTWEAR
420 E NORTH STREET
CARLISLE PA 17013
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QTRlYR. CONTRIBUTION INTEREST DUE ON UNPAID PENALTY DUE -
DUE PAID/CREDIT CONTRIBUTION AND { OR LATE REPORT{
BALANCE CONTRIBUTION PAID LATE. DISHONORED CHECK
3-99 WE .00 .00 .00 .00
3-99 560.25 90.35 469.90 30.54 56.03
4-99 WE .00 .00 .00 .00
4-'-99 302.31 .00 302.31 14.11 30.23
4-99 CP 100.00
I su b-tota I 772.21 44.65 186.26
.
Additional interest is to be computed on the above balance of unpaid unemployment
compensation contributions at the rate determined by the Secretary of Revenue
under Seotion 806 of the Fisoal Code, 72 P.S. ij 808, per month, or frection of a
month, from 08/31/2000 .
l'tm!il..iiW~~!:!Il:!*g
Filing Fee(s) .. . .~9.bd .
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Additional Interest
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The undersigned, Director, Bureau of j:::mployer Tax Operations, Department of Labor and Industry, certifies that the above unemployment compensation contributions, Interest and penalties
are due and payable by the above named defendant under the proillslons of the Pennsylvania Unemployment Compensation Law. Pursuant to Sect10n 308,1 of said Law, 43 P.S. ~ 788.1,
the above contributions, Interest and penalties are a Hen upon the franchises and properly, both real and personal, Including after acquired property, of the above named defendant and
attach thereto from the date of entry of this Certified Copy of Uen.
R Jut1f1~
R. SCOT MiEDRiCH
Assistant Director, Bureau of Employer Tax Operations
TO BE RETAINED BY RECORDING OFFICE
F'Jt-~?Zt,N',q;~
08/04/2000
DATE
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