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IN THE COURT OF COMMON PLEAS OF DOCKETW, 44j0bg a-vilTwo
CUMBERLAND COUNTY,PENNSYLVANIA 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 Executive' 'Decision LLC
Compensation Law,43 P.S.§788.1, 145 Walden Way
this is a Certified Copy of Lien for Mechanicsburg, PA 17050
unpaid unemployment compensation
contributions, interest and penalties to
be entered of record by you and
indexed as judgments are indexed.
AD Number: 635828
CONTRIBUTIONS, INTEREST and/or LATE REPORT PENALTIES
QTR/ REPORT CONTRIBUTION CONTRIBUTION PAYMENTS/ BALANCE INTEREST PENALTY TOTAL
YEAR STATUS TYPE DUE CREDITS DUE DUE asof* DUE DUE
10/28/2014
4/2013 Amended Employer $11,973.52 $11,973.52 $0.00 $0.00 $0.00
1/2014 Filed Withholding $309.85 $0.00 $309.85 $13.92 $3231.77
1/2014 Filed I Employer 1 $13,835.37 1 $0.001 $13,835.37 1 $622.621 $14,457.99
TOTAL $14,781.76
*Unemployment compensation contributions bear interest at the rate of one-twelfth Grand Total $14,781.76
(1/12)of the annual rate determined by the Secretary of Revenue under Section 806 $21.50
Filing Fee(s)
of the Fiscal Code,72 P.S.§806,or at the rate of three quarters of one per centum
(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.
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SALLY L. PIATAK
Assistant Director,Office of Unemployment Compensation Tax Service UC-72820141028104904181745878714
Department of Labor&Industry I Office of UC Tax Services 1 651 Boas Street I Harrisburg, PA 17121-0750 1 www.uc.pa.gov
*&1.5c) P0 PLFF
Auxiliary aids and services are available upon request to individuals with disabilities. C,-t3o�-10_�'W7
UC-728 REV 07-14(page 2) Equal Opportunity EmployerlProgram
IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF LABOR AND INDUSTRY
to the use of the
UNEMPLOYMENT COMPENSATION FUND
V.
Executive Decision LLC
145 Walden Way
Mechanicsburg,
PA 17050
: Docket Number 146808CIV
AUTHORITY TO REMOVE LIEN
TO THE PROTHONOTARY OF SAID COURT:
r\)
NOW, to wit, December 31, 2014, the Commonwealth of Pennsylvania, Department of Labor and Industry, to the
use of the Unemployment Compensation Fund, Plaintiff in above action, through its Chief Counsel, by its Deputy Chief
Counsel for Employment Security, desires that the above captioned Lien be removed from record.
AND you, the Prothonotary of said Court, are hereby authorized and empowered, in the name and stead of the
Plaintiff, to remove said Lien from the record as fully and effectually, to all intents and purposes, as we could were we
present in person to do so; and for so doing, this shall be your sufficient warrant of authority.
IN TESTIMONY WHEREOF, there is hereunto affixed the Seal of the Department of Labor and Industry,
Commonwealth of Pennsylvania.
AD Number: 635828
Sean F. Creegan
Deputy Chief Counsel
For Employment Security
ti
ID -28520141231074055374038999276
43IO.0OPA PU. F
048011
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