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04/17/2013 WED 15:45 FAX 402 471 4429 UCC SECRETARY OF STATE <br />L <br />Date: April 17, 2013 <br />201303060 <br />Employer or <br />Liable Person: Jesus Castaneda d/b /a J C Welding <br />Address: 1116 W Oklahoma Grand Island NE 68801 <br />Qtr. / Yr. Date Assessed <br />Combined Tax Or Payment In Lieu <br />Of Contributions Due <br />4- <br />i <br />TOTAL Combined Tax or Payment in Lieu of Contributions Due (under this lien only): <br />T_ \DOCUMENTS \FORMS \Liens \Original lien.docx <br />RETURN FILED COPIES TO: Nebr. Dept. of Labor - LEGAL <br />P.O. Box 94600 <br />Lincoln, NE 68509 -4600 <br />By: <br />Penalty <br />Hall <br />Hall_ I <br />Federal ID No. / SSA No.: j 20- 3856452/ xxx -2333 r I <br />1— <br />r <br />or <br />1 <br />-+ <br />, Agency Legal Counsel <br />S A. UKINSKI, Legal Counsel <br />I�004/ <br />NE Soo of Siale John A Gole - UCC STL <br />9913713201 -2 Pss: <br />CASTANEDA JESUS <br />Filed: 04/17/2013 10:32 AM <br />Interest <br />!, Through <br />I 4/12/2013 <br />STATE TAX LIEN o NEBRASKA DEPARTMENT OF LABOR <br />• 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 />NDOL Serial No.: FLAB- 0142 -2013 _ To be filed with the Register of Deeds in the following Counties: <br />NDOL Acct. No.: I <br />This State Tax Lien is issued for unpaid combined taxes (Neb. Rev. Stat §§48 -657 and 48 -664) or payments in lieu of contributions (Neb. Rev. Stat. §48- 660.01) pursuant <br />to the Uniform State Tax Lien Registration & Enforcement Act (Neb. Rev. Stat. §77 -390 I, el seq.). Notice is given that combined taxes or payments in lieu 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 />Subtotal <br />2/2012 3/28/2013 1 $1,830.33 I $28.201 $230.10 $2,088.63 <br />3/2012 3/28/2013 ? $1,830.33 I $28.201 $147.08 $2,005.61 <br />4/2012 3/28/2013 _ $1,830.33 $28.20 $64.07 <br />—i -1-- ----- <br />i_ 4 1 l <br />T <br />$1,922.60 <br />$ 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 />$6,016.84 <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 />Commi <br />NEBR. DEPT. OF LABOR <br />CHARGE ACCT. #1476 <br />