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IN THE COURT OF COMMON PLEAS OF DOCKET NUMBER: 14- 3�r%n
CUMBERLAND COUNTY, PENNSYLVANIA DATE ENTERED:
CERTIFIED COPY OF LIEN COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF LABOR AND INDUSTRY
TO THE USE OF THE --:�
UNEMPLOYMENT COMPEN�TICW-FUNb
t- -�
TO THE PROTHONOTARY OF SAID COURT: vs. MW -
Pursuant toSection 308.1ofthe • �� � `ten
Pennsylvania Unemployment E B CLEARING INC
Compensation Law,43 P.S. §788.1, 6820 WERTZVILLE RDS?
this is a Certified Copy of Lien for ENOLA, PA 17025 '
unpaid unemployment compensation c _ c;4
contributions, interest and penalties to • �„- --+' `
be entered of record by you and --� �
indexed as judgments are indexed.
AD Number: 624391
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
04/16/2014
1/2011 Filed Withholding $0.03 $0.03
1/2011 Filed Employer $3.72 $3.72
2/2011 Amended Withholding $53.77 $0.01 $53.76 $13.20 $66.96
2/2011 1 Amended Employer $4,545.71 $0.00 $4,545.71 $1,124.97 $5,670.68
4/2011 Filed Withholding $39.73 $0.00 $39.73 $8.10 $47.83
4/2011 Filed Employer $1,282.65 $0.00 $1,282.65 $259.74 $1.542.39
1/2012 Filed Withholding $49.70 $0.00 $49.70 $8.88 • $58.58
1/2012 Filed Employer $6,135.66 $0.00 $6,135.66 $1,104.48 $7,240.14
2/2012 Filed Withholding $57.04 $0.00 $57.04 $9.03 $66.07
2/2012 Filed Employer $2,124.64 $0.00 $2,124.64 $334.53 $2,459.17
4/2012 Filed Withholding $0.31 $0.3,
4/2012 Filed Employer $5.481 $77.10 $32.58
TOTAL l $17,238.46
*Unemployment compensation contributions bear interest at the rate of one-twelfth Grand Total $17,238.46
(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 I wwW.dli.state
Auxiliary aids and services are available upon request to individuals with disabilities.
UC-728 REV 01-14(page 2) Equal Opportunity Employee/Program
SALLY L. PATAK IIII INN
III
Assistant Director,Office of Unemployment Compensation Tax Service UC-72820140421130215517189582382
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Department of Labor&Industry I Office of UC Tax Services 1 651 Boas Street I Harrisburg, PA 17121-0750 1 www.d1m.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