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O 1 HE d ROTHO OTAR,T
?W DEC 12 PM 3: tab '12
IN THE COURT f# MU ?gFy DOCKET NUMBER:
CUMBERLAND COOWWWAVIL4ANIA DATE ENTERED:
TO THE PROTHONOTARY OF SAID COURT:
Pursuant to Section 308.1 of the •
Pennsylvania Unemployment WWI LLC
Compensation Law, 43 P.S. § 788:1, Attn: Jose 207 House Avenue Suite 107
this is a Certified Copy of Lien for Camp Hill, PA 17011
unpaid unemployment compensation
contributions, interest and penalties to •
be entered of record by you and
indexed as judgments are indexed.
AD Number: 607798
CONTRIBUTIONS, INTEREST and /or LATE REPORT PENALTIES
QTR/ REPORT CONTRIBUTION CONTRIBUTION PAYMENTS/ BALANCE INTEREST PENALTY TOTAL
YEAR STATUS TYPE DUE CREDITS DUE DUE as of * DUE DUE
11/20/2013
4/2009 Filed Employer $4.50 $4.50
1/2010 Filed Employer $27.36 $27.36
1/2011 Filed Employer 1 $560.88 $184.87 $376.01 1 $87.421 $463.43
2/2011 Filed Employer $221.641 $209.411 $12.231 $2.52 i $14.75
3/2011 Filed Employer $65.971 $62.321 $3.651 $0.751 $4.40
TOTAL $514.44
*Unemployment compensation contributions bear interest at the rate of one - twelfth Grand Total $514.44
(1/12) of the annual rate determined by the Secretary of Revenue under Section 806
of the Fiscal Code, 72 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 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.ea.us
Auxiliary aids and services are available upon request to individuals with disabilities. (. " �
UC -728 REV 09 -10 (page 2) Equal Opportunity Employer /Program
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UC- 72820131126153125999617208013
Department of Labor & Industry I Office of UC Tax Services 1 651 Boas Street I Harrisburg, PA 17121 -0750 1 www.dli.state.
Auxiliary aids and services are available upon request to individuals with disabilities.
UC -728 Rev 09-10 (page s) Equal Opportunity Employer; Program