HomeMy WebLinkAbout03-6456UC-728 REV. 9-03
IN THE COURT OF COMMON PLEAS OF
CUNgERnAND COUNTY, PENNSYLVANIA
CERTIFIED COPY OF UEN
TO THE PROTHONOTARY OF SAID COURT:
Pursuant to Section 308.1 o! 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 ere indexed.
PENNSYLVANIA EMPLOYER
ACCOUNT NUMBER: 21-21166 4
AD Number: 303565
DOCKET #
DATE ENTERED
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF LABOR AND INDUSTRY
TO THE USE OF THE
UNEMPLOYMENT COMPENSATION FUND
VS.
DOUGLAS GELBAUGH INDIVIDUALLY &
TRADING AS GELCO CARPET CLEANING
6380 BAYSHORE RD
MECHANICSBURG PA 17050
QTR/YR. CONTRIBUTION
DUE PAID/CREDIT BALANCE
4-01 WE .00 .00 o00
4-01 76.96 .00 76.96 7.76
1-02 WE .00 .00 .00
1-02 112.16 .00 112.16 9.63
2-02 WE .00 .00 .00
2-02 143.22 .00 143.22 10.14
.00
25.00
.00
25.00
.00
.00
sub-total
332.34 27.53 50.00
14 O0
'ditlonal interest is to be computed on the above balance of unpaid unemproyment Filirl~ Fee(s) ·
mpensation oonthbutions at the rate determined by the Secretary of Revenue
dar Section 806 of the FisoaJ Code, 72 P.$. $ 806, per month, or fraction of a Additional Interest
~nth, from 11/30/2003
SALLY L. FUHRER
TO BE RETAINED BY
RECORDING OFFICE
11/25/2003
DATE
6
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