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UC-728 REV, 6-98
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a<.:rt La;;Uf 1:S-
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
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DATEEN"~J:lE& ' i~t1 3: ::??
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CUM!?~ii'LA'J,} COUNTY
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CERTIFIED COPY OF LIEN
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF LABOR AND INDUSTRY
TO THE USE OF THE
UNEMPLOYMENT COMPENSATION FUND
TO THE PROTHONOTARY OF SAID COURT:
Pursuant to Section 308.1 of the
Pennsylvania Unemployment
Compensation Law, 43 P .5. ~ 788.1,
this is a Certified Copy of Lien for
unpaid unemployment compensation
contributions, interest and penalties to
be entered of record by you and
indexed as judgments are indexed.
.
vs.
MELRETTA SIMPSON
INDIVIDUALLY & T/A
MELRETTA'S COMMERCIAL SERVICE
914 SPRING CIRCLE
MECHANICSBURG PA 17055
.
PENNSYLVANIA EMPLOYER
ACCOUNT NUMBER: 21-19665 7
AD Number:
287623
.
QTRlYR CONTRIBUTION INTEREST DUE ON UNPAID PENAL TV DUE
DUE PAID/CREDIT CONTRIBUTION AND / OR LATE REPORT/
BALANCE CONTRIBUTION PAID LATE. DISHONORED CHECK
4-99 WE .00 .00 .00 .00
4-99 275.50 275.50 .00 .00 27.55
1-00 WE .00 .00 .00 .00 I
,
1-00 1,604.39 1,604.39 .00 32.09 160.44 I
,
2-00 WE .00 .00 .00 .00 I
2-00 4,257.37 1,443.84 2,813.53 75.03 .00 I
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2..813.53 107.12 187.99 I
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'A..,.ll!aIDirl~~.'..G;l. t~. ~t .,.,.,.,.,.,.,.,.,.....,.....,.,...,.............,...............~...:...~...~.........,.........,......................................................... .
.. ,..,........,....'...'.'.""'" .... .... .'. .'::f::'ff'::f:f::::'::"ff'lflf i
iI::I::$~t!;~il~ij,'~~iij~f,:,..':ttttIlf..i:"..,.,.,",.,.."."..,...,..,..,..',..,.....,.......,',.,.,.,.,','"\',\',',',',','"""',','",,,,",,',,',,, i
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 Section 806 of the Fiscal Code, 72 P.S, 6806, per month, or fraction of a
month, from 11/30/2000 .
The undersigned, Director, Bureau of Employer 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 provisions of the Pennsylvania Unemployment Compensation Law. Pursuant to Section 308.1 of said Law, 43 P.S. fi 788.1,
the above contrlbutlons, 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 Jut?f1~
R, SCOT MIEDRICH
11/27/2000
DATE
AsslsteJ'lt Director, Bureau of Employer Tax Operations
TO BE RETAINED BY RECORDING OFFICE
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