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01-1334
uc-728 ~EV. S-SS' IN THE COURT OF COMMON PLEAS OF CUMEERLAND COUNTY, PENNSYLVANIA 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. PENNSYLVANIA EMPLOYER ACCOUNT NUMBER: 21-190@3 7 AD Number: 288416 Oi- /33¥ DOCKET # DATE ENTERED COMMONWEALTH OF PEI~LV~IIA ii:[:~ DEPARTMENT OF LABOR AI~:~INDUSTRY.:;~ TO THE USE OF 91~ ~) _~ ;£i ~' UNEMPLOYMENT eOMP N . ON v,. CHARLES D KTGER JR INDIVIDUALLY & T/A SALON AMBIANCE 160 BOBBY JONES DRIVE ETTERS PA 17319 QTR/YR, CONTRIBUTION INTERESTDUEONUNPAID PENALTYBUE- CONTRIBUTION AND / OR LATE REPORT! DUE PAID/CREDIT BA~NCE CONTRI~UTIONpA:DLATE. ~ISHONOREOCHECK 4-97 WE .00 .00 .00 .00 4-97 82.95 82.95 .00 8.29 25.00 1-98 WE .00 .00 .00 .00 1-98 66.30 42.05 24.25 8.53 25.00 2-98 WE .00 .00 .00 .00 2-98 58.67 45.50 13.17 2.57 25.00 3-98 WE .00 .00 .00 -00 3-98 43.03 .00 43.03 7.42 25.00 sub-total 80.45 26.81 10o.oo Additional interest ia to be oomputed on the above ba[anoe of unpaid unemployment Filing Fee(s) 9.0 0 compensation contributions at the rate determined by the Seoretary of Revenue under Section 806 of the Fiscal Code, 72 P,$, § 806, per month, or fraction of a Additional Interest R. SCOT MIEDRICH 01/26/2001 TO BE RETAINED BY RECORDING OFFICE Z Z~ Z~ ~m Z~ o. w~_~ ~ ~ ~Zzmm ~w--~ O--Z · ~ w o ~ 0 E .12 ..5 .-~ It) © o o