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UC-728 REV, 6.98
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
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CERTIFIED COPY OF LIEN
DOCKET #0/- (,. s-S"J'Cu;,;t ~
DATE ENTERED
TO THE PROTHONOTARY OFSAID 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.
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF LABOR AND INDUSTRY
TO THE USE OF THE
UNEMPLOYMENT COMPENSATION FUND
vs.
.
GREAT LOCATION INC
T/A KOKOMO'S
3721 MARKET ST
CAMP HILL PA 17011
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PENNSYLVANIA EMPLOYER
ACCOUNT NUMBER: 21-20051 4
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AD Number:
292501
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QTRlYR,
DUE
CONTRIBUTION
PAID/CREDIT
BALANCE
INTEREST DUE ON UNPAID
CONTRIBUTION AND J OR
CONTRIBUTION PAID LATE.
PENAL TV DUE -
LATE REPORT!
DISHONORED CHECK
1-01 WE
1-01
.00
3,187.98
.00
.00
.00
3,187.98
167.37
.00
250.00
sub-total
Additional interest is to be computed on the above balanoe of unpaid unemployment
compensation contributions at the rate determined by the Sacretary of Revenue
under Section 806 of the Fiscal Code, 72 P,S, g 806. per month, or fraction of a
month. from 11/30/2001 .
Additional Interest
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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 30a,1 of sald Law, 43 P,S, ~ 766.1,
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,
RJut1f1~
R, SCOT MIEDRICH
11/01/2001
DATE
Assistant Director, Bureau of EmployerTal< Operations
TO BE RETAINED BY RECORDING OFFICE
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