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NDOL Serial No.: <br />LAB -0083 -2013 <br />To be filed with the <br />a is er of Deeds in the foll�� Counties: <br />NDOL Acct. No.: <br />0319367007 <br />Hall <br />2/20/2013 <br />Federal ID No. /'SSA No.: <br />20- 5330632 <br />$126.83 <br />$ 313.83 <br />Qtr. / Yr. <br />Date Assessed <br />Combined Tax Or Payment In Lieu <br />Of Contributions Due <br />1# al y <br />NO P' u <br />Interest <br />Through <br />3/7/2013 <br />Subtotal <br />3/2008 <br />2/20/2013 <br />$162.00 <br />$ 5.00 <br />$126.83 <br />$ 313.83 <br />4/2008 <br />2/20/2013 <br />$0.00 <br />$ 5.00 <br />$0.00 <br />$ 25.00 <br />1/2009 <br />2/20/2013 <br />$162.00 <br />$0.00 <br />$112.37 <br />$ 274.37 <br />2/2009 <br />2/20/2013 <br />$1 62.00 <br />$25.00 <br />$105.02 <br />$ 292.02 <br />3/2009 <br />2/20/2013 <br />$0.00 <br />$25.00 <br />$0.00 <br />$ 25.00 <br />2/2010 <br />2/20/2013 <br />$311.76 <br />: $ 5.00 <br />$146.01 <br />$ 482.77 <br />3/2010 <br />2/20/2013 <br />$311.76 <br />$ 25.00 <br />$131.87 <br />$ 468.63 <br />4/2010 <br />2/20/2013 <br />$311.76 <br />$25.00 <br />, ,$45.00 <br />'$45.00 <br />$117.73 <br />$104.05 <br />$89.91 <br />$ 454.49 <br />$ 440.81 <br />$ 426.67 <br />1/2011 <br />2/20/2013 <br />$311.76 <br />$311.76 <br />2/2011 <br />2/20/2013 <br />3/2011 <br />2/20/2013 <br />$311.76 <br />- $25.00 <br />$75.77 <br />$ 412.53 <br />4/2011 <br />2/20/2013 <br />$311.76 <br />$25.00 <br />$61.63 <br />$ 398.39 <br />1/2012 <br />2/20/2013 <br />$233.64 <br />- $5.00 <br />25.00 <br />$35.82 <br />$25.23 <br />$ 294.46 <br />$ 283.87 <br />2/2012 <br />2/20/2013 <br />$233.64 <br />3/2012 <br />2/20/2013 <br />$233.64 <br />:} 5.00 <br />$14.63 <br />$ 273.27 <br />4/2012 <br />2/20/2013 <br />$233.64 <br />;> ' $ 5.00 <br />4.03 <br />$ 262.67 <br />$ 0.00 <br />TOTAL Combined Tax or Payment in <br />Lieu of Contributions Due (under this lien only); ": " ` <br />$5,128.78 <br />03/14/2013 THU 14:46 FAX 402 471 4429 UCC SECRETARY OF STATE <br />STATE TAX LIEN 0 NEBRASKA DEPARTMENT OF LABOR <br />is ORIGINAL <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 />Thls Stat Tax Llen Is issued for unpaid combined taxes (Neb. Rev. Stat. § §48 -657 and 48 -664) or payments in lieu of contributions (Neb. Rev. Stat. <br />§48 660.01) pursuant to the Uniform State Tax Lien Registration & Enforcement Act (Neb. Rev. Stat. §77 -3901, et seq.). Notice is given that combined <br />taxes or payments in lieu of contributions, interest (computed at 1.5% per month), and penalties are due from this employer or person and remain unpaid <br />after demand. These combined taxes or payments in lieu of contributions constitute a lien for any and all personal property and real property in the <br />county/counties named, belonging to the employer or person, whether now owned or hereafter *go . <br />I certify that the Nebraska Department of Labor has complied with the Employment $purity Law of the State of Nebraska in the <br />determination of the amount due, and the employer or person has failed to pay the ar putt due after demand. <br />CATHERINE LANG <br />Comm' ....: bor <br />Date: March 14, 2013 <br />Employer or <br />Liable Person: Klingers Plumbing & Heating Inc. <br />Address: 120 West 9' Wood River NE 68883 -0312 <br />T:(DOCUMENTS\FORMS\Liens \Original lien (12 +qus).docx <br />20130199 <br />By: <br />•■y <br />Hall 2J003 /004 <br />JOH _ B , agency Legal Counsel <br />T j A I ISKI, Legal Counsel <br />- ucc STL <br />9913710673 -8 Pas: 1 <br />K PLUMBING & HEATING IN <br />Filed: 03/14/2013 09:55 AM <br />