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IN THE COURT OF COMMONYZ I AND C0 DOCKET NUMBER �3
CUMBERLAND COUNTY, PENNSY LVAN I DATE ENTERED:
TO THE PROTHONOTARY OF SAID COURT:
Pursuant to Section 308.1 of the •
Pennsylvania Unemployment UNI -MART CONY STORE
Compensation Law, 43 P.S. § 788.1, 216 S 3RD ST
this is a Certified Copy of Lien for LEMOYNE PA 17043
unpaid unemployment compensation
contributions, interest and penalties to
be entered of record by you and
indexed as judgments are indexed.
AD Number: 607866
CONTRIBUTIONS, INT and /or LATE REPORT PENALTIES
INTEREST PENALTY TOTAL
QTR/ REPORT CONTRIBUTION CONTRIBUTION PAYMENTS/ BALANCE DUE as of
YEAR STATUS TYPE DUE CREDITS DUE 11/20/2013 DUE DUE
1/2009 Amended Withholding $0.12 $0.12
1/2009 Amended Employer $3.26 $3.26
4/2009 Amended Employer $271.81 $251.25 $20.56 $6.90 $25.00 $52.46
1/2010 Employer $776.20 $0.00 $776.20 $250.26 $79.78 $1,106.24
212010 Employer $488.71 $0.00 $488.71 $146.80 $50.56 $686.07
4/2010 Employer $454.25 $0.00 $454.25 $115.94 $48.51 $618.70
1/2011 Employer $2,586.63 $0.00 $2,586.63 $601.40 $250.00 $3,438.03
2/2011 Employer $1,628.57 $0.00 $1,628.57 $341.88 $165.39 $2,135.84
3/2011 Employer $782.54 $0.00 $782.54 $146.75 $80.41 $1,009.70
1/2012 Employer $2,274.85 $0.00 $2,274.85 $32414 $23073 $2,829.72
TOTAL $11,880.14
*Unemployment compensation contributions bear interest at the rate of one - twelfth Grand Total $11,880.14
(1/12) 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.
Department of Labor & Industry I Office of UC Tax Services 1 651 Boas Street I Harrisburg, PA 17121 -0750 1 www dli state pa.us
Auxiliary aids and services are available upon request to individuals with disabilities. f at d
UC - 728 REV 09 - 10 (page 2) Equal Opportunity Employer /Program S �
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UC- 72820131126144145774815445960
Department of Labor & Industry I Office of UC Tax Services 1 651 Boas Street I Harrisburg, PA 17121 -0750 1 www.dli.state.pa.us
Auxiliary aids and services are available upon request to individuals with disabilities.
UC-728 REV 09 -10 (page 3) Equal Opportunity Employer /Program
1- 'O
IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA
COMMONWEALTH OF PENNSYLVANIA : Docket Number 137325CIV
DEPARTMENT OF LABOR AND INDUSTRY
to the use of the • r -
UNEMPLOYMENT COMPENSATION FUND •
-ri r
V. • Con rf N
UNI-MART CONV STORE r-
216S3RDST •
LEMOYNE PA 17043 •
CD
AUTHORITY TO SATISFY
TO THE PROTHONOTARY OF SAID COURT:
NOW, to wit, 01/21/2014, the Commonwealth of Pennsylvania, Department of Labor and Industry, to the use of the
Unemployment Compensation Fund, Plaintiff in above action, through its Chief Counsel, by its Deputy Chief Counsel for
Employment Security, acknowledges having received of the Defendant above named full payment and satisfaction of the
above captioned Lien, with the interest and costs thereon due it; and desire that satisfaction be entered upon the records
thereof.
AND you, the Prothonotary of said Court, upon receipt by you of your costs, are hereby authorized and empowered, in the
name and stead of the Plaintiff, to enter full satisfaction upon the record of said Lien as fully and effectually, to all intents
and purposes, as we could were we present in person to do so; and for so doing, this shall be your sufficient warrant of
authority.
IN TESTIMONY WHEREOF, there is hereunto affixed the Seal of the Department of Labor and Industry, Commonwealth
of Pennsylvania.
Sean F. Creegan
Deputy Chief Counsel
For Employment Security
AD Number: 607866
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