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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 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: 602114
CONTRIBUTIONS, INTEREST and/or LATE REPORT PENALTIES
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF LABOR AND INDUSTRY
TO THE USE OF THE
UNEMPLOYMENT COMPENSATION FU ND
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YORK ROAD DINER IN
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160 YORK ST ~, r
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YEAR REPORT
STATUS CONTRIBUTION
TYPE CONTRIBUTION
DUE PAYMENTSI
CREDITS BALANCE
DUE INTEREST
DUE as of"
09/24/2012 PENALTY
DUE TOTAL
DUE
3/2008 Assessed Withholding $25.31 $0.00 $25.31 $9.12 $34.43
3/2008 Assessed Employer $1,562.20 $0.00 $1,562.20 $562.56 $158.75 $2,283.51
1/2010 Assessed Withholding $25.77 $0.00 $25.77 $5.70 $31.47
1/2010 Assessed Employer $2,152.29 $0.00 $2,152.29 $484.20 $217.81 $2,854.30
2/2010 Assessed Withholding $33.75 $0.00 $33.75 $6.75 $40.50
2/2010 Assessed Employer $2,818.38 $0.00 $2,818.38 $570.78 $250.00 $3,639.16
TOTAL $8,883.37
`Unemployment compensation contributions bear interest at the rate ofone-twelfth Grand Total $8,883.37
(1112) of the annual rate determined by the Secretary of Revenue under Section 806 $21.50
of the Fiscal Code, 72 P.S. § 806, or at the rate of three quarters of one per centum Filing Fee(S)
(0.75%), whichever is greater, for each month or fraction of a month from the
date they are due through the date they are paid. Additional interest will accrue on the
above balance of unpaid contributions until they are paid.
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 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.
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Department of Labor & Industry i Office of UC Tax Services ~ 651 Boas Street ~ Harrisburg, PA 17121-0750 ~ www.dli.state.pa.us
DOCKET NUMBER: ~ - `7189" ~-Vl~i~'rW
DATE ENTERED:
Auxiliary aids and services are available upon request to individuals with disabilities.
UC-728 REV 09-10 (page 2) Equal Opportunity Employer/Program
~~
SALLY L. PIATAK
Assistant Director, Office of Unemployment Compensation Tax Service
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UC-72820121106103551149666948579
Department of Labor & Industry ~ Office of UC Tax Services ~ 651 Boas Street I Harrisburg, PA 17121-0750 I www.dli a pa ~s
Auxiliary aids and services are available upon request to individuals with disabilities.
UC-728 REV 09-10 (page 3) Equal Opportunity Employer/Program