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IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
CERTIFIED COpy OF LIEN
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.
PENNSYLVANIA EMPLOYER
ACCOUNT NUMBER: 21-19309 7
AD Number:
288278
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DATE EN~EO:: {)
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COMMONWEALTH OF PE~YUiINIA(j:~'
DEPARTMENT OF LABOR *@INDJ?STF\!S~i;
TO THE USE OF TI1IE;::::> c,~!
UNEMPLOYMENT COMPENSA<tIOtHI'UN~
vs.
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JOHN T SMITH & ROBARTcJ THORSON
INDIVIDUALLY & AS ~R~ER~ T/A
WHY NOT RESTAURA~~ ~TE~~~G
959 TRINDLE ROAD ~g:J == '.'~
. CARLISLE PA 1701~~ ;;; ,iZ
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CONTRIBUTION. INTEREST DUE ON UNPAID PENAL TV DUE
QTR/YR, CONTRIBUTION AND I OR LATE REPORTI
DUE PAID/CREDIT . BALANCE CONTRIBUTION PAID LATE. DISHONORED .CHECK
1-99 WE .00 .00 .00 .00
1-99 376.26 .00 376.26 50.48 37.63
2-99 WE .00 .00 . .00 .00
2-99 428.44 25.00 403.44 49.13 42.84
I su b-tota I 779.70 99.61 80.47
Additional Interest is to be computed an the above balance 01 unpaid unemployment
compensation contrlputlons at the rate determined by the Secretary 01 Revenue
under Section 806 of the Fiscal Code, 72 P,S, ~ 806, per month, or Iraction 01 a
month, from 01/31/2001 .
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Additional Interest
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The underslgn,d, Director, Bureau of Employer Tax Operations, Department of Labor and Industry, certifies that the above untfmployment compensation contrIbutions, Interest and penallles
are due and pelyable by the above named defendant under the proVisions of the Pennsylvania Unemployment Compensation Law. PUfsuantto Section 308.1 of said Law, 43 P.S. g 788.1,
the ai:l~e contributIons, Int9l'9st and penaltIes are a llen upon the 1fe.t\chlses end property, both real end p.el'aOnal, IncludIng after acquIred property, 01' the above named de1endent and
attach thereto from the date of entry of this Certified Copy of Lien.
R ,jut1l1~
R. SCOT MIEDRICH
AssIstant DIrector, Bureau of Employer Tax OperatIons
TO BE RETAINED BY RECORDING OFFICE
01/02/2001
DATE
IN THE COURT OF COMMON PLEAS OF
COUNTY. PENNSVLVANIA
DnCKET #
DATE ENTERED
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF LABOR AND
INDUSTRY
TO THE USE OF THE
UNEMPLOYMENT COMPENSATION
FUND
VS.
CERTIFIED COpy OF LIEN UNDER
PENNSVLV ANIA UNEMPLOYMENT
COMPENSATION LAW
Prothonotary
NOTICE TO DEFENDANT OF ENTRY OF LIEN
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This is the Certified Copy of Lien which has been filed with the Prothonotary of the Court
designated on the reverse side of this notice,
The Department of Labor and Industry of the Commonwealth of PElnnsylvaliia, at the expiration of
ten (1 0) days after the receipt of this notice, is authorized by law to execute upon this lien, This
means that your property may be levied upon, attached and sold to the extent necessary to
satisfy this lien, Execution will not occur if this lien is satisified,
Payment should be made by a Cashiers Check, Certified Check or Money Order made payable to
the Pennsylvania Unemployment Compensation Fund, The Pennsylvania Employers Account Number,
as shown on the reverse side of this document, should be affixed to the lower left corher of
the remittance and mailed to the address below:
Bureau of Employer Tax Operations
Post Office Box 60 1 30
Harrisburg, Pennsylvania 17 1 06-0 130
Any questions concerning this Lien should be addressed to the nearest Field Accounting Ser.vice
office at the address or telephone number shown on the enclosure, or call telephone number
(717) 787-2009 or (717) 783-8418.
The symbol "WE", if shown on this Lien, refers to the "Withholding for Employee" contributions,
The symbol "CP". if shown on this Lien, refers to the "Check Penalty" charged for a dishonored
check.
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