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UC-728 REV. 6-98
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
DOCKET#t{?_~~~q ~
DATE ENTERED
CERTIFIED COPY OF LIEN
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF LABOR AND INDUSTRY
TO THE USE OF TJ;!!:
UNEMPLOYMENTCOMPENSiTldiFU~Q
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KENNETH G BURRY W.E; en ;!';q
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INDIVIDUALLY & ~lP -0 i!:.r;
KEN'S ELECTRIC :Z8 :x ';;2<'.'5
401 PINE ROAD :J>~' 1;".' ~,r,
MT HOLLY SPRINGS 1~6~
. Ul -<
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 Certifie.d Copy of Lien 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: 21-18769 0
rck~ loLl 7 t, 9
AD Number: 287364 ~(i-tX!J ~.4- 'NT~/::~ ;p~f
QTRlYR. CONTRIBUTION. PENAL TV DUE
DUE PAlO/CREDIT CONTRIBUTION AND I OR lATE REPORTI
BALANCE CONTRIBUTION PAID lATE. DISHONORED CHECK
4-98 WE .00 .00 .00 .00
4-98 68.45 .00 68.45 9.41 25.00
1-99 WE .00 .00 .00 .00
1-99 169.92 .00 169.92 20.39 25.00
2-99 WE .00 .00 .00 .00
2-99 361.55 .00 361.55 37.06 36.16
3-99 WE .00 .00 .00 .00
3-99 328.98 .00 328.98 27.96 32.90
4-99 WE .00 .00 .00 .00
4-99 223.60 .00 223.60 14.91 25.00
I sub-total 1 152.50 109.73 144.06
. . . ffibllll "i.!af,!!1l$#~!ltI
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... ...Ad~ltlo.nal..lnte.relSt...
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Additional Interest is to be computed on the above balance of unpaid unemployment
compensation contributions at the rate determined by the Seoretary of Revenue
under Section 806 of the Ascal Code, 72 P.S. 6 806, per month, or fraction of a
month, from 11/30/2000 .
The undersigned, Director, Bureau of Employer Ta)( Operations, Department of Labor, and Industry, certijles that the above unemployment compensation contributions, Interest and penalties
are due and payable by the above named defendant under the provisions of the Pennsylvania Unemployment Compensation Law. Pursuant to Section 308.1 of said Law, 43 P,S. i 788.1,
the above contributions, Interest and penalties are a lien upon the franchises and property, 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 Lien.
R Jut1l1~
R. SCOT MIEDRICH
11/08/2000
DATE
Assistant Director, Bureau of Employer Ta)( Operations
TO BE RETAINED BY RECORDING OFFICE
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