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BUREAU OF COMPLIANCE DEPARTMENT OF REVENUE
PO BOX 280948 REVK-159(12-12)REVOOOK9 DOCEXEC
HARRISBURG PA 17128-0948
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OF THE, PP(OTjj'0N0TlCERTIFIED COPY OF LIEN +�tLj,,3q ),t
2014 JUL -$ AM 9: 4 4 COURT OF COMMON PLEAS OF V/
CUMBERLAND COUNTY,
IUMBERLAND COUNTY PENNSYLVANIA
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CHURCHTOWN CHURCH NIAEIN:................................................23-7409392/000
351S OLD STONEHOUSE RD Notice Date:....................................May 20,2014
BOILING SPRIGS PA 17007-9665 Notice Number:...............................793-261-614-051-5
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
EMPL 15739733 01-01-12 03-31-12 0.00 20.39
EMPL 15739733 04-01-12 06-30-12 0.00 78.15
EMPL 15739733 07-01-12 09-30-12 0.00 10.39
EMPL 15739733 01-01-13 03-31-13 22.04 126.35
EMPL 15739733 04-01-13 06-30-13 23.58 75.65
TOTAL: 45.62 310.93
FILING FEE(S): 21.50
SATISFACTION FEE(S): 10.00
SETTLEMENT TOTAL: 342.43
INTEREST CALCULATION DATE: 08-13-14
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.
May 20,2014
ErtbrARY OF REVENUE DATE
(OR UTHORIZED DELEGATE) PART I -TO BE RETAINED BY RECORDING OFFICE OL if
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