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DOCKET # c4. - '-/!..? CivJ .-r;~
DATE ENTERE:D:
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
(J,L P4 t /'/.0":)
CERTIFiED COpy OF LIEN
CJL /2 If., f
~ ! 13191
TO THE PROTHONOTARY OF SAID COURT:
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF LABOR AND INDUSTRY
TO THE USE OF THE
UNEMPLOYMENT COMPENSATION FUND
vs.
Pursuant to 43 P.S. 5 5 874(a) and 788.1, this is a
Certified Copy of Lien for overpaid unemployment
compensation benefits and interest to be entered of
record by you and indexed as judgments are
indexed.
DAVID T. JOHNSON
157 LINCOLN STREET
CARLISLE, PA 17013
Social Security Account Number: XXX-XX-0025
Additonal interest will accrue on the balance due of
the above overpaid unemployment compensation
benefits after 12/31/05. For the total amount due
on this lien, phone (717) 783-3140.
Job Center # 0996
Claim Week OVerpaid
End;ns Date Amount
01/29/00 $t01.00
OV05/00 $101.00
OV1 VOO $101.00
OV19/00 $101.00
OV26/00 $101.00
03/04/00 $101.00
03/11/00 $101.00
03/18/00 $101.00
03/25/00 $101.00
Claim Week
Endtng Date
Overpaid
Amount
Claim Week
Ending Date
Overpaid
Amount
Claim Week
Ending Date
Overpaid
Amount
Minus Amount Repaid
$495.00
The undersfgned, Assistant Director, BUf9U of Unemployment Compensation Benefits and Allowances, Department of Labor and Industry of the
Commonwealth of Pennsylvania, certifies that the above person is obltgated, pursuant to 43 P.S. , 874(8) to repay the above overpa;d
unemployment compensation benefits received by him/her together with interest thereon, charged per month or fraetton of a month,
beginning fifteen (15) days after the Notice of Overpayment was issued and continuing until the overpaid benefits are repaid. The interest rate
is determined by the Secretary of Revenue as provided by Section 806 of the Fiscal Code. In accordance with 43 P .5. S S 874(10) and 788.1, the
above overpaid unemployment compensation benefits and interest are a lien upon the franchises and property, both real and personal,
inetudins after.acquired property, of the above person and attach thereto from the date of entry of this Certified Copy of Lien.
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Chief of VI Claims Services
January 20, 2006
Date
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