HomeMy WebLinkAbout04-5516UC-728 REV. 4-04
IN THE COURT OF COMMON PLEAS OF
¢ U M ]3 E R L A N D COUNTY, PEN NSYLVANIA
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: 21-20113
DOCKET #
DATE ENTERED
cos
DEPARTMENT OF LABOR AND INDUSTRY
TO THE USE OF THE
UNEMPLOYMENT COMPENSATION FUND
VS.
KEVIN J SHRAWDER
INDIVIDUALLY & T/A
AUTO EFFEX
1322 SPRING ROAD
CARLISLE PA 17013
AD Number: 3 0 8 8 5 1
QTR/YR, CONTRIBUTION
DUE PAID/CREDIT
1-03 WE .12 .00
1-03 32.17 .00
2-03 WE 5.59 .00
2-03 1,555.72 .00
3-03 WE 4.83 .00
3-03 701.09 .00
4-03 WE 4.96 .00
4-03 925.57 .00
2-04 WE 18.20 18.20
2-04 1,759.80 181.80
BALANCE
INTEREST DUE ON UNPAID
CONTRIBUTION AND / OR
CONTRIBUTION PAIO LATE.
PENALTY DUE -
LATE REPORT/
O{SHONOREQ CMECK
· 12 .00
32.17 2.15 25.00
5.59 .00
1,555.72 84.56 156.13
4.83 .00
701.09 29.41 70.59
4.96 .00
925.57 27.91 93.05
· 00 .00
1,578.00 15.78 .00
sub-total
Iditicnal interest is to be computed on the above balance of unpaid unemployment
mpensation contributions at the rate determined by the Secretary of Revenue
der Section 808 of the Fiscal Code. 72 P,S. § 806, per month, or fraction of a
mth, from 1 0 / 3 1 / 2 0 0 4
4 , 808
Filing Fee(s).
Additional Interest
The undersigned, Assistant Director, C~fice of Unemployment Compensation Tax Services, Department of Labor and Industry, certifies that the above unemployment compensation
contributions, interest and penalties are due and pe. yab~a 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 end penalties ere e. lien upon the franchises end property, both reel 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,
SALLY L. FUHRER
Assistant Director, Office of Unemployment Compensation Tax Services
TO BE RETAINED BY RECORDING
OFFICR
10/15/2004
DATE
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