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IN THE COURT O~ ~ ;~?~~~~,~~8lOF
CUME3ERLAND 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.
AD Number: 603424
CONTRIBUTIONS, INTEREST and/or LATE REPORT PFNAI TIFF
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF LABOR AND INDUSTRY
TO THE USE OF THE
UNEMPLOYMENT COMPENSATION FUND
vs.
• SIMPSON FERRY 5202 INC
"Trading as"
TOKYO DINER OF MECHANICSBURG
5202 SIMPSON FERRY RD, SUITE 108
MECHANICSBURG, PA 17050
QTRJ
YEaR REPORT
STATUS CONTRIBUTION
TYPE CONTRIBUTION
DUE PAYMENTS/
CREDITS BALANCE
DUE INTEREST
DUE as of *
11/09/2012 PENALTY
DUF TOTAL
DUE
3l2C ;8 Amended Employer $3,935.04 $3,935.04 $0.00 $0.00 $0.00
4/20 i8 Filed Employer $974.57 $974.57 $0.00 $0.00 $0.00
1/20 ;9 Filed Employer $1,693.95 $1,693.95 $0.00 50.00 $0.00
2/20.;9 Filed Employer $1,139.59 51,139.59 $0.00 30.00 $0.00
3/20 -9 Filed Employer $731.89 $731.89 $0.00 $0.00 $0.00
4/20`;9 Filed Employer $1,244.30 $1,244.30 $0.00 $0.00 $0.00
1/20'0 Filed Employer $2,074.15 $2,074.15 $0.00 $0.00 $0.00
2/2010 Filed Employer $1,175.94 $1,175.94 $0.00 $0.00 $0.00
3/2010 Filed Employer $683.25 $683.25 $0.00 $0.00 $0.00
4/2010 Filed Employer $1,627.43 $1,627.43 $0.00 $0.00 $0.00
1/2011 Filed Employer $1,898.04 $1,646.42 $251.62 $35.91 $287.53
2/2c`' 1 Filed Employer $1,222.83 $816.27 $406.56 $45.75 $452.31
3/20' 1 Filed Employer $777.22 $579.97 $197.25 $17.76 $215
01
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$954.85
*Une r !oyment cor~•,;;ensation contributions bear interest at the rate ofone-twelfth Grand Totul $954.85
(1/17; 'the annual cite determined by the Secretary of Revenue under Section 806
of th:i scal Code, rl P.S. § 806, or at the rate of three quarters of one per centum Filing Fee(s) $21.50
(0.75';: ,whichever is greater, for each month or fraction of a month from the
date t~ y are due th; ough the date they are paid. Additional interest will accrue on the
above glance of unraid contributions until they are paid.
The under ,igned, 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.
~~-, ~runeni v. ~aoor ~ industry I Uttice of UC Tax Services ~ 651 Boas Street ~ Harrisburg, PA 17121-0750 ~ www dli state rya uc
Auxiliary aids and services are available upon request to individuals with disabilities. ~ a ~'1I a pl~-
UC -' ' 8 REV o9- ;age z) Equal Opportunity Employer/Program n dd
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DOCKET NUMBER: I ~`~ `
DATE ENTERED:
auY ~,~,
SALLY L. PIATAK
Assisi nt Director, :i~fice of Unemployment Compensation Tax Service
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UC-72820121109102841571810064846
De; ~rtment of Labor & Industry ~ Office of UC Tax Services ~ 651 Boas Street ~ Harrisburg, PA 17121-0750 ~ www.dli.s a a us
Auxiliary aids and services are available upon request to individuals with disabilities.
UC-728 REV os-io;pages~ Equal Opportunity Employer/Program