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IN THE COURT OF COMMON PLEAS OF .~ --
DATE ENTERS o
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COUNTY, PENNSYLVANIA
CUMBERLAND 0 7 • ~l (0 0 ( ~..( ~.~.,. ~
CERTIFIED COPY OF LIEN COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF LABOR AND INDUSTRY
TO THE USE OF THE
UNEMPLOYMENT COMPENSATI ON FUND
TO THE PROTHONOTARY OF SAID COURT:
Pursuant to Section 308.1 of the vs.
Pennsylvania Unemployment
Compensation Law, 43 P.S. § 788.1,
this is a Certified Copy of Lien for •
INDNIDUALLY &
SON NGUYEN
unpaid unemployment compensation ,
T/A TLC JANITORIAL SERVICES
contributions, interest and penalties to 671 WILLOW ST
be entered of record by you and LEMOYNE PA 17043
indexed as judgments are indexed.
ACCOUNT NUMBER: 21-23807-4
AD Number: ~j Q 3) ~'~
QTRlYR CONTRIBUTION INTEREST DUE ON UNPAID
CONTRIBUTION AND / OR PENALTY DUE
(see reverse for
DUE PAID/CREDIT BALANCE CONTRIBUTION PAID LATE explanation)
1/OSWE $ 28.19 $ 28.19 $ 0.00 $ 0.00 $ 0.00
1/OS 3,277.03 2,405.82 871.21 216.60 0.00
3/OSWE 18.38 18.38 0.00 0.00 0.00
3/05 2,136.84 2,136.84 0.00 8.98 215.52
1/06WE 6.46 6.46 0.00 0.00 0.00
1/06 981.08 750.47 230.61 33.32 98.75
2/06WE 1.95 0.00 1.95 0.00 0.00
2/06 296.82 0.00 296.82 26.89 29.88
"W E" refers to withholding for employee contributions. SUb-total $1,400.59 $285.79 $344.15
Additional interest is to be computed on the above balance of unpaid Total ~L,U.~U.J3
unemployment compensation contributions at the rate of one-twelfth
(1/12) of the annual rate determined by the Secretary of Revenue under Flling Fee(S) 19.00
Section 806 of the Fiscal Code, 72 P.S. § 806, per month or fraction of Additional Legal Costs
a month, or at the rate of three quarters of one per centum (0.75%) per
month or fraction of a month, whichever is reater, from the date they Additional Interest
become due until paid, from 07/31/7
Satisfaction Amount
The undersigned, Assistant Director, Office of Unemployment Compensation Tax Services, 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. § 788.1, 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.
Sally L. Piatak
Assistant Director, Office of Unemployment Compensation Tax Services
July 20, 2007
DATE
TO BE RETAINED BY RECORDING OFFICE
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