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BUREAU OF COMPLIANCE DEPARTMENT OF REVENUE
PO BOX 280948 REVK-159(12-12)REV0001<9 DOCEXEC
HARRISBURG PA 17128-0948 j
T CERTIFIED COPY OF LIEN
A Y 2 7
CUMBERL,4N COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY,
N N S Y L-VA'_'
OUNTY PENNSYLVANIA
QIU , MEI L P E N i EIN:................................................20-0251116/000
825A W KING ST Notice Date:....................................April 20,2014
SHIPPENSBURG PA 17257-9201 Notice Number:...............................749-074-614-041-5
To the Prothonotary of said court: Pursuant to the laws of the
Commonwealth of Pennsylvania,there is herewith transmitted a certified
copy of a lien to be entered of record in your county.
1 2 3 4 5 6
TAX TYPE ACCOUNT ID TAX TAX TAX TOTAL
PERIOD PERIOD
BEGIN END
SALES 83017403 06-01-13 06-30-13 10.19 12.98
SALES 83017403 07-01-13 07-31-13 9.53 12.05
SALES 83017403 10-01-13 10-31-13 919.32 1,102.59
TOTAL: 939.04 1,127.62
FILING FEE(S): 21.50
SATISFACTION FEE(S): 10.00
SETTLEMENT TOTAL: 1,159.12
INTEREST CALCULATION DATE: 07-14-14
The undersigned,the Secretary of Revenue or authorized delegate of the Commonwealth of Pennsylvania,certifies this to be a true and correct copy
of a lien against the above-named taxpayer for unpaid tax, interest, additions or penalties therein due from such taxpayer and which,after demand for
payment thereof, remains unpaid. The amount of such unpaid tax, interest, additions or penalties is a lien in favor of the Commonwealth of
Pennsylvania upon the taxpayer's property-real,personal or both-as the case may be.
April 20,2014
S S `C UTARY OF REVENUE DATE
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PART 1 -TO BE RETAINED BY RECORDING OFFICE 0W I,Soiod
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