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12/13/2012 THU 14:33 FAX 402 471 4429 UCC SECRETARY OF STATE <br />STATE TAX LIEN 0 NEBRASKA DEPARTMENT OF LABOR <br />• ORIGINAL <br />Employer or <br />Liable Person: <br />Address: <br />NDOL Serial No.: <br />NDOL Acct. No.: <br />Federal ID No. / SSA No.: <br />Qtr. / Yr. I Date Assessed <br />2/2012 1 9/6/2012 <br />3/2012 - 11/14/2012 <br />Date: December 13, 2012 <br />T :IDOCUMENTSTORMSu.uens \Original lin.docx <br />Combined Tax Or Payment In Lieu <br />Of Contributions Due <br />RETURN FILED COPIES TO: Nebr. Dept. of Labor - LEGAL <br />P.O. Box 94600 <br />Lincoln, NE 68509 -4600 <br />2 01210580 <br />By: <br />TH <br />a -0y <br />Hall <br />LAB - 0474 -2012 <br />0331662001 <br />26- 4764122 <br />2002/002 <br />NE Sec of Skate John A Gale - UCC <br />111111 1111 <br />9912704530 -5 p gs: <br />Filed: PEKING /13//2012 INC 15 PM <br />New Peking Palace Inc. f/d/b /a Peking Palace <br />3421 W. State St. Ste 6 Grand Island NE 68803 <br />To be filed with the Re inter of Deeds in the followin Counties: <br />Hall <br />111 <br />NDOL Office of Legal Counsel <br />P.O. Box 94600 <br />Lincoln, NE 68509 -4600 <br />Telephone - (402) 471 -9912 <br />FAX - (402) 471 -9917 <br />This State Tax Lien is issued for unpaid combined taxes (Neb. Rev. Stat. § §48 -657 and 48-664) or a _ I <br />to the Uniform State Tax Lien Registration & Enforcement Act (Neb. Rev. Stat. §77 -3901, et s eq.). Noticelis of giv l that o combined taxes payments lin pursuant <br />of <br />contributions, interest (computed at 1.5% per month), and penalties are due from this employer or person and remain unpaid after demand. These combined taxes or <br />payments in lieu of contributions constitute a lien for any and all personal property and real property in the county/counties named, belonging to the employer or person, <br />whether now owned or hereafter acquired. <br />Interest <br />I Penalty Through <br />i 11/29/2012 <br />1 <br />$213.33 I $0.00 $12.73 <br />$74.14 1 $25.00 $1.06 <br />L <br />I <br />Labor <br />Agency Legal Counsel <br />S A. UICINSKI, Legal Counsel <br />Subtotal <br />I <br />-L <br />TOTAL Combined Tax or Payment in Lieu of Contributions Due (under this lien only): <br />y $ 326.26 <br />I 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 employer or person has failed to pay the amount due after demand. <br />CATHERINE D. LANG <br />Commissi• • . <br />$ 226.06 <br />$ 100.20 <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 />$ 0.00 <br />$ 0.00 <br />NEBR. DEPT. OF LABOR <br />CHARGE ACCT. #14765 <br />t1 , <br />