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PA DEPARTMENT OF REVENUE Pennsylvania ~
BUREAU OF COMPLIANCE
LIEN SECTION DEPARTMENT OF REVENUE
PO BOX 28Q948
HARRISBURG PA 17128-0948
REV-159 CM DOLE XEC (1 U-09J
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COURT OF COMMON PLEAS OF CUMBERLAND COUNTY. PENNSYLVANIA ~ "~' c,rD
NAME AND ADDRESS:
SHIRLEY BAKER
IND AND AS TREASURER OF
BAKER CARBURETION INC
6354 BRANDY LANE
MECHANICSBURG PA 17050
TO THE PROTHONOTARY OF SAID COURT: CERTIFIED COPY OF LIEN
Pursuant to the laws of the Cow nwea lth of Pennsylvania.
snare is narewftn tnans.ittee a cenifiaa cave of alien 202385063
to ee enteraa of recare in your county
CLASS OF TAX PERIOD DATE OF ASSESSMENT
DETERMINATION OR IDENTIFYING
TAX
(OR DUE DATE)
SETTLEMENT
NUMBER TAX TOTAL
1 2 3 4 5 6
EMPLOYER 10/08-12/08 JUN 12 2012 022405-03 0.00 150.17
EMPLOYER 01/09-03/09 JUN 12 2012 022405-03 0.00 102.16
SALES 04/08-06/08 JUN 12 2012 022405-03 372.60 627.22
SALES 10/08-12/08 JUN 12 2012 022405-03 0.00 100.41
SALES 01/09-03/09 JUN 12 2012 022405-03 0.00 90.65
TOTALS
5372.60 51070.61
INTEREST COMPUTATION DATE DEC 2 5 2 0 1 2 FILING FEE(S)
$21.50
The undersigned, the Secretaryy of Revenue (or his authorized delegate) of the Commonwealth of SATISFACTION FEE(S)
of alien against the above-named
l
ani
rtifies this to be a true and correct co
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c
$ 1 0 ' 0 0
py
e
sy
v
a,
e
interest
additions or penalties thereon due from such taxpayer
taxpayer for unpaid tax
,
,
ADDITIONAL INTEREST
and which, after demand for payment thereof, remains unpaid. The amount of such unpaid
tax, interest, additions or penalties is a lien in favor of the Commonwealth of Pennsylvania
real, personal or both, as the case may be.
upon the taxpayer's prop
ert
y,
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~~i/// ~l SETTLEMENT TOTAL
51102.11
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SEP 26 2012 c~llal8a9~5~
SECRETARY OF REVENUE DATE ,~~ a8~yU7
(OR AUTHORIZED DELEGATE) PART 1 - TO BE RETAINED BY RECORDING OFFICE