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HomeMy WebLinkAbout06-0657 BUREAU OF COMPLIANCE PO BOX 280946 HARRISBURG. PA 17128-0946 fd...- P-Yi f !'! (J() Ck. ,;;>JON REV-159 01 AFP (6/96) ~. )12713 (") ...., = 0 r.:; C.:J " 0"' i-~- ...., :r ", m fn ::0 I -oF; :,"r.JCJ ::J(l.) =2 :,:.:':f; ) --- ..;.;". .,~ C) r:-:> tsrn .'.:.1 ", Sj 0 ,< COURT OF COMMON PLEAS OF CUMBERLAND 90461779 COUNTY, PENNSYLVANIA fLu. 0(" t 5'"7 CwJ I~ NAME AND ADDRESS: ROBERT H BLACK IND AND AS PRESIDENT OF R H BLACK INC CUSTOM PATIO ROOMS OF CENTRAL PA 1788 N MEADOW DRIVE MECHANICSBURG PA 17055 TO THE PROTHONOTARY OF SAID COURT: PURSUAr-.T TO THE LAWS OF THE COMMONWEALTI-I OF PENNSYLVAN1,~ THERE lSHEREWITHTRANSMITTED A CERTIFIED COPY OF LlEN CERTIFIED COPY OF LIEN TO BE ENTERED OF RECORD IN YOUR COUNTY DATE OF CLASS OF TAX PERIOD ASSESSMENT IDENTIFYING TAX TOTAL TAX (OR DUE DA TEl DETERMINATION NUMBER OR SETTLEMENT EMPL 4-1-04 10 12-31-04 10-5-05 CO-99999 $9,052.74 $16,125.84 TOTALS $9,052.74 $16,125.84 FILING FEE (5) $14.00 INTEREST COJ\IPl,TATION DATE 4-11-06 T)le under,igned, lhe Secretary "frevenue (Of his authorized delegate) (If the Commonwealth ADDITIONAL INTEREST ofPennsylvania.certifLesthj,tobelrueandcorreclcapyofalienagainst lheabove named ta:Kpllyer t0ll.l[\p~idt3". Interest. adllit'ons or pena!ties thereon due from such ta~payer and which. after demand for payment thereo[ remains unpaid The amount of such unpaid ta~, Inlerest, addilionsOl penaltie, isa lien in favor of the tommonwealth "fPennsyjvania upon SETTi,EMl<:L"lT TOTAL thela~l'ayer'sl'roP~;V"eal,l""S{\nal,"rbOlh,as'hecascmaybe , ~ ~ /' /, /...::/' /;~~..//' , '<? :./ . ~':':/t.-(~).""'....-r;"-..___,___.. SECRETARY~6iREVE:'ollIE ' (OR AlITHORIZED /lELEGATE) PART I ~TO BE RETAINED BY RECORDING OFFICE JAN 2 7 2006 DATE n, f ~ ~ . . <> "" .." . , ~ '" .., .. '; :: , " "';:~ ~i? n. . , , On" . , . ::l,'T', ~ ; ~ " . ~ , " . . . n . . , ~ ~ ~ , n . " ;: . 2. . , , 0 ~ ; n o , , , . . ;;;; r,;; :: ~ ~ ,';:: : g : ~ . . ~ . . , . . ~~'" , " . , . . . . r . . ~ ~ ~ a . ~ . ~ "" ~ . , . "" g [ ~ ~ ~~g: g :;":;<" ;j ~ ~ ~ ~ a~ ~ ::. II> . , . . . . , .- . . :i":;:';; ~ Z : . , . " . ;:; ~ 4 ~ ~ ~ , . . , o " . <> "'::l., . . :.r 1:' " ~ ~ ~ : -:;. x ~ , : - :;. ;' . ' . . . ".a ..." . 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