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05/03/2012 T8U 15:10 FAX 402 471 4429 UCC SECRETARY OF STATE -�-�y 8a1.1 <br />� <br />� <br />20120� <br />[�ooz/ooa <br />STATE TAX LIEN ❑ NEBRASKA, DEPARTMENT OF LABOR <br />■ ORIGINAL <br />NDOL Office of Legal Counsel <br />P,O. Bog 94600 <br />Lincoln, NE 68509-4600 <br />Telephone - (d02) 471-9912 <br />FAX - (402) 471-9917 <br />Employer or . <br />Liable Person: Jesus Castaneda d/b/a J C Welding <br />� Address: 1 I 16 W. Oklahoma Grand Island NE 68801 <br />NDOL Senial No.: LAB-0180 2012 To be filed with the Re ister of Deeds in the followin Counties: <br />NDOL Accti No.: 0312448005 Hall <br />Federal ID No. / SSA �To.: 20.3856452 /�ac 2333 <br />This Soate Tax Lien is issued for ungaid combined taates (Neb. Rev. Stat. §§48-657 aad 48-554) ar payments sn lieu of contributions (Neb. Rev Stm. §48-bb0.01) pursuent <br />W the Unifiorm State Tex Lien Registtation & EnforcemetR Act (Neb. Rev. Swt §77 3901. et seg.). Notice is given that combiaed t�ces or payments ia lieu of <br />contrt'butiaac, interest (computed at 1.5% per month), aad penalti� are due from this employer or pe�son aad remain unpeid a8er demend. These combined tax� or <br />payments in lieu of contributions constitute a lien for any and all personat properiy and real property in the countyicaunties n�nmed, belonging to the employer or peison, <br />whether now owned or here�after acquired. <br />Qtr. / Yr. <br />3/2009 <br />4l2009 <br />]/2010 <br />2/2010 <br />1/2011 <br />2/2011 <br />3/ZO11 <br />4/2011 <br />Date Assessed <br />4/1212012 <br />4/12/2012 <br />4/12/2012 <br />4/12/2012 <br />4/12/2012 <br />4/12/2012 <br />ai�2�zoiz <br />4/12/2012 <br />$0.00 <br />$44.97 <br />$�11.18 <br />$439.96 <br />$170.75 <br />$0.00 <br />$0.00 <br />TOTAL Combined Tag or Paymeat.in Lien of Contributioas Due (under ti►is lien only): <br />$0.00 $12.68 <br />$0.00 $191.11 <br />$0.00 --- $458.88 <br />$36.55 $222.99 <br />$0.00 $78.73 <br />$25.00 $22.81 <br />$25.00 $0.00 <br />$ 12.68 <br />$ 236.08 <br />$1,737.43 <br />$ 970.72 <br />$ 518.69 <br />$ 218.56 <br />$ 25.40 <br />$ 25,40 <br />$ 0.00 <br />$ 0.00 <br />$ o.00 <br />s o.00 <br />$3,744.16 <br />Y certify that the Nebraska Department of Labor has complied with the Employment Security Law of the State of Nebraska in the <br />determination of the amount due, and the empioyer or person has failed to pay the amount due after demand. <br />CATHERINE D. LANC� <br />Commissio o La <br />Date: May 3, 2012 BY� <br />O BIN, Agency Legal Coansel <br />T:1DOC[TN�NTSIFORMS�I,iens\Ociginal lien.docx O A. UKINSKI, Legal Counsel <br />RETURN FILED COPIES TO: Nebr. Dep� of Labor - LEGAL <br />P.O. Box 94600 <br />Lincoln,NE 68509-4600 <br />Combined Tag Or Payment In Liea <br />Of Contributions Due <br />Interest <br />Penalty Through Snbtotal <br />4/27i2012 <br />NEBR DEl'T. UF LABOR <br />CHARGE ACCT #14765 <br />W <br />