HomeMy WebLinkAbout10-4244UC-728 REV. 1-06
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
DOCKET # 10 - gcag4
DATE ENTERED
Evil l
rem
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.
ACCOUNT NUMBER:
AD Number: 346703
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF LABOR AND INDUSTRY
TO THE USE OF THE
UNEMPLOYMENT COMPENSATION FUND
VS.
FIRST CHOICE MEDICAL SUPPLY LLC
1018 MENDELL DAVIS DRIVE
BYRAM MS 39272
•
QTR/YR CONTRIBUTION INTEREST DUE ON UNPAID
/ OR
CONTRIBUTION N AND PENALTY DUE
I
. DUE PAID/CREDIT BALANCE L
ATE. seexplanation) or
4-09 WE 55.46 55.46 .00 .0C
4-09 1,702.28 583.00 1,119.28 56.34 .0C
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VE" refers to withholding for employee contributions. sub-total
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1,119.28 56.34 OC
Additional interest is to be computed on the above balance of unpaid unemployment T. otal 1,175.62
compensation contributions at the rate of one-twelfth (1/12) of the annual rate Filing Fee(s) 19. 00
determined by the Secretary of Revenue under Section 806 of the Fiscal Code, 72
P.S. § 806, per month or fraction of a month, or at the rate of three quarters of one Additional Legal Casts
per centum (0.7596) per month or fraction of a month, whichever is greater, from the Additional Interest
date they become due until paid, from 0 6 / 3 0 / 2 010. Sat-Wact(011Amount
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 Ilen 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 0 6 0 3/ 2 010
DATE
Assistant Director, Office of Unemployment Compensation Tax Services
TO BE RETAINED BY RECORDING OFFICE
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