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BUREAU OF COMPLIANCE DEPARTMENT OF REVENUE
PO BOX 280948 REVK-159(12-12)REV0001<9 DOCEXEC
HARRISBURG PA 17128-0948 ED-0
( T 0,
OF CERTIFIED COPY OF LIEN
PROTHONOTpjf�j #H,
2014 JUL -S A14 9: 4 4 COURT OF COMMON PLEAS OF V
CUMBERLAND C
CUMBERLAND COUNTY PENNSYLVANIA OUNTY,
PHOUASALITH EVWWi4,191P`LLC EIN:................................................27-3042416/000
3608 MARKET ST Notice Date:....................................May 20,2014
CAMP HILL PA 17011 -4323 Notice Number:...............................792-970-014-051-5
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
SALES 85180963 11-01-13 11-30-13 1,173.89 1,407.91
TOTAL: 1,173.89 1,407.91
FILING FEE(S): 21.50
SATISFACTION FEE(S): 10.00
SETTLEMENT TOTAL: 1,439.41
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
9i0brARY OF REVENUE DATE
(OR UTHORIZED DELEGATE)
PART 1 -TO BE RETAINED BY RECORDING OFFICE OILLk bo
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