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IN THE COURT OF COMMON PLEAS OF
CUKBERLAI:O COUNTY, PENNSYLVANIA
*
CERTIFIED COPY OF LIEN
TO THE PROTHONOTARY OF SAID COURT:
Pursuant to Section 308,1 01 the
Pennsylvania Unemployment
Compensation Law, 43 P.S, 5788.1,
thla Is a Certllled Copy 01 Lien for
unpaid unemployment compensation
contributions, Interest and penahles to
be entered 01 record by you and
Indexed as Judgments sre indexed,
PENNSYLVANIA EMPLOYER
ACCOUNT NUMBER: 21-17560 9
AD Number:
279782
aTR/YR, CONTRIBUTION
DUE PAID/CREDIT
1-95 WE 33.43 17,86
1-95 1,136.43 594.78
2-95 WE 33,78 25,43
2-95 895.82 895.82
3-95 WE 41,54 41. 54
3-95 540.84 368,12
4-95 WE 46,74 29.71
4-95 587.67 587,67
1-96 WE 9,59 4.95
1-96 600.23 328,00
sub-total
Addltlonal/ntBrast Is to be computed on the above balance of unpaId unemployment
compensation contributIons at the rate determined by the Secretary of Revenue
undor SOO1lon 806 of tho Fiscal Codo, 12 P.S, g 806, por month, or 1,",01lon 01 a
; month, from 03/31/1999 ,
DOCKET # q9-;)/ (pq G.w.O
DATE ENTERED I I.-. terM
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COMMO~WEALTH OF PENNSYLVANIA
DEPARTMENT OF LABOR AND INDUSTRY
TO THE USE OF THE
UNEMPLOYMENT COMPENSATION FUND
va,
.
EMERGENCY VETERINARY CENTER INC
11 WILLOW MILL PARK ROAD
MECHANICSBURG PA 17055
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INTEREST DUE ON UNPAID PENALTY our: ~
CONTRIBUTION AND I OR lATE REPORT!
BALANCE CONTRIBUTION PAID LATE. OISHONORED CHECK
15.57 ,00
541. 65 193.63 .00
8,35 ,00
.00 2,72 ,00
,00 .00
172,72 73.76 58,24
17.03 .00
,00 4,77 .00
4,64 ,00
272,23 71.29 .00
1 032.19
Total
Filing Fee(s)
Addttlonal Legal Costs
Additional Interest
SatIsfaction Amount
346,17
," ,,1.43,6,60,'" '
'" 9,00
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Thl Underllgned, Olr.ctor, Bur..u 01 Employ.r To Operatlont, Oepartment 01 Labor and Indu'try, Clrtlllll Ihlllhl abovI unemployment cemp.n..Uon conlribu1lonl, Imer..t and p.nall!..
at. dUI and payable by Ihl abovI namld d,Ilndenl under th, provlllonl 01 Ihe Penn.ylvanla Unemployment COmplnlAllon Law. PurlUMI to Section 308.1 01 ..Id Law, 43 P.S. I 788.1,
lh. abovI contribution., Inlerllt and ",naltl.. 41'1 . tI.n upon th"ranchl,.. and property, bolh rill and pI"onat, Including attet Icqulr.d property, ollh. above namld d.f'ndant and
attach I"lreta ttom lh, dat. of enlry 01 thll Certln,d Copy of U.n.
R Jut111~
R, SCOT MIEORICH
A..!ttant Director, Bur..u of Employ.r Tax Op.ratlonl
TO BE
03/15/1999
DATE