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IN THE COURTIOF+COMMDN LEAS OF DOCKET NUMBER:
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 Blinc Group Inc
Compensation Law,43 P.S.§788.1, 'Trading as"
this is a Certified Copy of Lien for Keeping It Green
unpaid unemployment compensation P.O. Box 21919
contributions, interest and penalties to ' York, PA 17402
be entered of record by you and
indexed as judgments are indexed.
AD Number: 631793
CONTRIBUTIONS, INTEREST and/or LATE REPORT PENALTIES
OTR/ REPORT CONTf21BUTION CONTRIBUT1014 PAYMENTS/ BALANCE INTEREST PENALTY TOTAL
YEAR STATUS TYPE DUE CREDITS DUE DUE as of* DUE DUE
10110120.14
1/2012 Filed Withholding $6.82 $6.82 $0.00 $1.50 $1.50
1/2012 Filed Employer $315.82 $315.82 $0.00 $71.10 $32.26 $103.36
2/2012 Amended Withholding $74.70 $74.70 $0.00 $14.58 $14.58
2/2012 Amended Employer $3,283.29 $753.15 $2,530.14 $609.74 $250.00 $3,389.88
3/2012 Filed Withholding $61.58 $61.58 $0.00 $11.04 $11.04
3/2012 Filed Employer $1,416.19 $0.00 $1,416.19 $265.50 $147.78 $1,829.47
4/2012 Filed Withholding $34.29 $34.29 $0.00 $5.46 $5.46
4/2012 Filed Employer $363.90 $0.00 $363.90 $60.06 $39.82 $4.63.78
1/2014 Filed Withholding $64.12 $64.12 $0.00 $2.88 $2.88
1/2014 Filed Employer $7,445.31 $0.00 $7,445.31 $390.88 $250.00 $8,086.19
TOTAL $13,908.14
*Unemployment compensation contributions bear interest at the rate of one-twelfth Grand Total $13,908.14
(1/12)of the annual rate determined by the Secretary of Revenue under Section 806 $21.50
of the Fiscal Code,72 P.S.§806,or at the rate of three quarters of one per centum Filing Fee(s)
(0.75%),whichever is greater,for each month or fraction of a month from the
date they are due through the date they are paid. Additional interest will accrue on the
above balance of unpaid contributions until they are paid.
The undersigned,Assistant Director,Office of Unemployment Compensation Tax Services,Department of Labor and Industry,certifies that
the above unemployment compensation contributions,interest and penalties are due and payable by the above named defendant under the
provisions of the Pennsylvania Unemployment Compensation Law. Pursuant to Section 308.1 of said Law,43 P.S.§788.1,the above
contributions,interest and penalties are a lien upon the franchises and property,both real and personal,including after acquired property,of
the above named defendant and attach thereto from the date of entry of this Certified Copy of Lien.
Department of Labor&Industry I Office of UC Tax Services 1 651 Boas Street I Harrisburg, PA 17121-0750 I www.uc.pa.gov
Auxiliary aids and services are available upon request to individuals with disabilitiesL1. ^
UC-728 REV 07-14(page z) Equal Opportunity EmployerjProgram L � c7
T:> AA__ 21u n<J,
SALLY L. PIATAK
Assistant stant D�rect r
. unemploymentOffice of
Compensation Tax service 1lTI.'
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UC-72820141105140650738532695523
Department of Labor&Industry I Office of UC Tax Services 1651 Boas Street I Harrisburg, PA 17121-0750 1 www.uc.pa.gov
Auxiliary aids and services are available upon request to individuals with disabilities.
UC=72$ REV 07-14(page 3) Equal Opportunity Employer/Program