HomeMy WebLinkAbout04-4682UC-728 REV. 4-04
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND 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 s 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: 21-21440 &
AD Number: 307941
DOCKET # 0
DATE ENTERED
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF LABOR AND INDUSTRY
TO THE USE OF THE
UNEMPLOYMENT COMPENSATION FUND
VS.
BETH ANN SHOVER
TRADING AS
MASSAGE THERAPY
2507 GETTYSBURG RD
CAMP HILL PA 17011
INDIVIDUALLY &
ASSOC[-~ TE~
CONTRIBUTION INTEREST DUE ON UNPAID PENALTY DUE -
CONTRIBUTION AND ! OR LATE REPORT/
QTR/YR. DUE PAID/CREDIT BALANCE CONTRIBUTIQN PAID LATE. DISHONORED CHECK
2-03 WE 3.56 3.56 .00 .00
2-03 633.93 259.76 374.17 30.58 97.31
4-03 WE 3.24 3.24 .00 .00
4-03 263.86 96.76 167.10 6.04 26.71
1-04 WE 19.28 19.28 .00 .00
1-04 1,187.81 115.72 1,072.09 18.60 .00
2-04 WE 8.40 8.40 .00 .00
2-04 484.41 16.60 467.81 3.12 .00
sub-total
2,081.17 58.34 124.02
tional interest is to be computed on the above balance of unpaid unemployment Filing Fee(s) 1 4.0 0
sensation contributions at the rate determined by the S.oratary of Revenue
ir Section 806 of the Fiscal Cods, 72 P,S, § 806, per month, or fraction of a Additional Interest
~h, from 09/30/2004
SALLY L, FUHRER
TO BE RETAINED
BY RECORDING OFFICE
09/07/2004
DATE
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