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IN THE COURT OFC�ON}1V9(�IV� f F DOCKET NUMBER: et
CUMBERLAND COUNi;,vPL VANIA DATE ENTERED:
CERTIFIED COPY OF LIEN COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF LABOR AND INDUSTRY
TO THE USE OF THE
UNEMPLOYMENT COMPENSATION FUND
TO THE PROTHONOTARY OF SAID COURT: vs.
Pursuant to Section 308.1 of the •
Pennsylvania Unemployment KEITH JONES
Compensation Law, 43 P.S. § 788.1, "Trading as"
this is a Certified Copy of Lien for ARCHER PEST CONTROL
unpaid unemployment compensation 1993 HUMMEL AVE, STE 101
contributions, interest and penalties to • CAMP HILL, PA 17011
be entered of record by you and
indexed as judgments are indexed.
AD Number: 621751
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
03/04/2014
4/2010 Assessed Withholding $3.50 $3.50
4/2010 Assessed Employer $25.00 $25.00
1/2011 Assessed Withholding $13.59 $6.28 $7.31 $2.85 $10.16
1/2011 Assessed Employer $384.72 $0.00 $384.72 $101.15 $39.83 $525.70
212011 Assessed Withholding $16.94 $0.00 $16.94 $4.16 $21.10
2/2011 Assessed Employer $81.75 $0.00 $81.75 $19.52 $25.00 $126.27
3/2011 Assessed Withholding $28.08 $0.00 $28.08 $6.09 $34.17
3/2011 Assessed Employer $302.97 $0.00 $302.97 $65.83 $33.10 $401.90
4/2011 Assessed Withholding $18.72 $0.00 $18.72 $3.64 $22.36
4/2011 Assessed Employer $25.00 $25.00
TOTAL $1,195.16
*Unemployment compensation contributions bear interest at the rate of one - twelfth Grand Total $1,195.16
(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. `
C1L.����IboS
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 01 - 14 (page 2) Equal Opportunity Employer /Program
SALLY L. RATAK
Assistant Director, Office of Unemployment Compensation Tax Service UC- 72820140313150045538863246219
Department of Labor & Industry Office of UC Tax Services 651 Boas Street Harrisburg, PA 17121 -0750 www.dli.state.pa.us
Auxiliary aids and services are available upon request to individuals with disabilities.
UC -728 REV 01 -14 (page 3) Equal Opportunity Employer /Program