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05-4786
UC-728 REV. 4-04 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA frl... p~ a/yo uu ck.. JO t. 'j ~ ;&v it,$(,) I CERTIFIED COpy OF LIEN TO THE PROTHONOTARY OF SAID COURT: Pursuant to Section 308.1 of the Pennsylvania Unemployment Compensation Law, 43 P.S. ~ 788.1, this is a Certified Copy of Lien for unpaid unemployment compensation contributions, interest and penalties to be entered of record by you and indexed as judgments are indexed. PENNSYLVANIA EMPLOYER ACCOUNT NUMBER: 21- 2 0333 5 AD Number: 313150 QTAJYR. DUE CONTRIBUTION PAID/CREDIT 1-05 WE 1-05 16.67 749.22 .00 .00 sub-total CO.) ::~-) -T-j CJl (,.., :~~.! . .! r ~ I DOCKET # DATE ENTERED c..". ._~ r' . tu,.O J' I.J 7 '/(.p ~ ( COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF LABOR AND INDUSTRY TO THE USE OF THE UNEMPLOYMENT COMPENSATION FUND vs. . DOE & JERRY'S INC 902 N FRONT ST WOMRLEYSBURG PA 17043 . INTEREST DUE ON UNPAID CONTRIBUTION AND J OR BALANCE CONTRIBUTION PAID LATE. PENAL TV DUE .. LATE REPORTI DISHONORED CHEC 16.67 749.22 15.96 .0 ( .0 ( Additional interest is to be computed on the above balance of unpaid unemployment compensation contributions at the rate determined by the Secretary of Revenue under Section 806 of the Fiscal Code, 72 P.S. ~ 806, per month, or fraction of a month,from 09/30/2005 ..... ...FilingFee(sL...... ...A~Cilt@OftlgEtgftlyQ$t~i.................... .... Additional Interest 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 30B.1 of said Law, 43 P.S. fi 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 .0 6~' M' ~"" .o~, ""m.o '0'0 " 0"'" "'." 00"", 0'", '" Uo" SALLY L. FUHRER Assistant Director, Office of Unemployment Compensation Tax Services TO BE RETAINED BY RECORDING OFFICE 09/02/2005 DATE c( \A-~ 0,> (I)..J c(~ ~z o..m zo.. o . o,z'>" o,z~ 0:::> 00 \A-O o ~ :::> o o ~ '- m ~ \A- o ~ ~ Ul \A- o ~ < ~ Ul ~ o t- ~ g Z * ~ ~ . 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