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UQ-728 REV, 8-98
t'fJ d1 &H D1S
f\ *t ~iWOF 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.S. ! 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: 21-20782 9
AD Number:
289826
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DATE ENTERED
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF LABOR AND INDUSTRY
TOTHEUSEOFTH~. a ~
UNEMPLOYMENTCOMPENSA~NTUND71
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NEWVILLE FA 17241~'('
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QTRlYR. CONTRIBUTION INTEREST DUE ON UNPAID PENAL TV DUE -
DUE PAID/CREDIT CONTRIBUTION AND I OR LATE REPORTI
BALANCE CONTRIBUTION PAID LATE. DISHONORED CHECK
1-98 WE .00 .00 .00 .00
1-98 792.47 792.47 .00 161.14 .00
2-98 WE .00 .00 .00 .00
2-98 783.56 783.56 .00 151.98 .00
3-98 WE .00 .00 .00 .00
3-98 471.10 471.10 .00 73.51 .00
4-98 WE .00 .00 .00 .00
4-98 250.74 250.74 .00 38.95 .00
1-99 WE .00 .00 .00 .00
1-99 1,144.32 .00 1,144.32 187.86 .00
2-99 WE .00 .00 .00 .00
2-99 928.27 769.44 158.83 118.84 .00
I sub-total 1 303.i5 732.28 .00
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 05/31/2001 .
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Filing Fee(s)
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Additional Interest
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The undersigned, Director, Bureau of EmployerTa>< Operations, Depllrtment of Labor and Industry, certifies that the above unemployment compensatIon contributions, Interest and penalties
are due and payable by the above named defendant under 1he provisions of the P9nnsylvanla Unemployment Compenslltlon Law. Pursuant to Section 308.1 of said Law, 43 P.S. Ii 788.1,
tl1e llbove contributions, Interest and penalties are a lien upon the franchises and property, both realllnd personal, Including after llcqulred property, of the above named defendant and
attach thereto from the date of entry of this Certified Copy of Lien.
RJutPJ~
R. SCOT MIEDRICH
Assistant Director, Bureau of Employer Tax Operations
TO BE RETAINED BY RECORDING OFFICE
OS/23/2001
DATE
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