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06/04/2012 MON 15:24 FAX 402 471 4429 UCC SECRETARY OF STATE '~~~ Hall <br />� <br />, <br />2U12U���4� <br />NDOL Offlce of Legal Counsel <br />_ P.O. Bog 94600 <br />Lincoln, NE 68509-4600 <br />TeIephone - (402) 471-9912 <br />FAX - ( 402) 471- 9917 <br />STATE TAX LIEN ❑ NEBRASKA DEPARTMENT OF LABOR <br />■ ORIGDY.AI. <br />r,mpioyer or <br />Liable Person: Ronald F. I{mg f/d/b/a RK Pub <br />Address: 316 E 2 St. Grand Island NE 68801 <br />NDOL Serial No.: LAB-0206-2012 To be fded with the Re ister of Deeds in the followin Connties: <br />_ NDOL Acct No.: 0309728001 Hall <br />^ Federal ID No. / SSA No.: 87-071292U/aooc-7944 <br />This State Tax Lien is issued for unpaid wmbiaed �xes (Neb. Rev. Stat §§48�57 end 48-664) or payments in tieu of co�ributiona (Neb, Rev Star� §48-660.01) p�usuant <br />Co' the Uniform State Tex Lien Registration 8c F.nforcemem Act (Neb. Rev Stat. §77 3901, et seg.). Nodce is given ti�at combined tax� or paymenta in lien of <br />contributions, interest (compured at 1.5% per month), and penal6es are due frotn this empioyer or person and remain unpaid after demend. These combined texes or <br />payments in lieu of contribuGons constitute a Gen for any and all personal property and real property in the county/coun6es nemed, be(ongiag to the employer or person, <br />whether now• owaed or hereafter acquired. <br />Qtr. / Yr. <br />3/2010 <br />4/2010 <br />1/2011 <br />2f2011 <br />Date Assessed <br />5/7/2012 <br />si�noiz <br />5/7/20I2 <br />5/7/2012 <br />$4.88 <br />$356.31 <br />TOTAL Combined Tax or Payment in Lieu of Contributions Due (under this lien only): <br />�oo�/ooa <br />Interest <br />Penalty Through Subtotal <br />5/22/2012 <br />$0.00 <br />$0.00 <br />$25.00 <br />$0.00 <br />$1.37 <br />$84.12 <br />$63.57 <br />$9.22 <br />$ 6.25 <br />$ 440.43 <br />$ 420.91 <br />$ '12.42 <br />$ 0.00 <br />� 0.00 <br />$ 0.00 <br />$ 0.00 <br />$ 0.00 <br />$ 0.00 <br />$ 0.00 <br />$ 0.00 <br />$ 940.0] <br />I certify that t6e Nebraska Department of Labor has eomplied with t6e Employment Security Law of the State of Nebraska in the <br />determination of the amount due, and the employer or person has failed to pay the amount due after demand. <br />CATHER � D. LANG <br />Co �ssioner f or <br />Date: June 4, 2012 g <br />JO . ALBIN, Agency Legal Coansel <br />T:�DOCt7MENTS\FORMS1Liens\Original lien.docx MA,S A. UKINSKI, Legal Counsel <br />� <br />RETURN F'�ILLED COPIES TO: Nebr. Dept of Labor - LEGAL NEBR DEPT. OF LABOR <br />p.o. so: sa600 cHARCE AccT. #14765 <br />Liocoln, NE 68509-460U /�,� <br />\y / <br />Combined Tag Or Payment In Lieu <br />Of Contributions Due <br />� <br />