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Qtr. /'Yr. <br />Date Assessed <br />Combined Tax Or Payment In Lieu <br />Of Contributions Due <br />Penalty <br />Interest <br />Through <br />8/142013 <br />Subtotal <br />4/2007 <br />7/302013 <br />$0.00 <br />$0.00 <br />$65,63 <br />$ 65.63 <br />1/2008 <br />7/30/2013 <br />$0.00 <br />$0.00 <br />$1,114.45 <br />$1,114.45 <br />2/2008 <br />7/30/2013 <br />$0.00 <br />$0.00 <br />$2124 <br />$ 21.24 <br />1/2009 <br />7/30/2013 <br />$93.42 <br />$0.00 <br />$604.66 <br />$ 698.08 <br />2/2009 <br />7/30/2013 <br />$23.03 <br />$0.00 <br />816.75 <br />t $ 39.78 <br />3/2009 <br />7/302013 <br />$0.00 <br />840.61 <br />$0.00 <br />$ 40.61 <br />1/2010 <br />7/30/2013 <br />$651.51 <br />$0.00 <br />$388.74 <br />$1,040.25 <br />80.00 <br />$ 0.00 <br />$ 0.00 <br />$ 0.00 <br />TOTAL Combined Tax or Payment in <br />Lieu of Contributions Due (under this tin nmru). <br />02 (Yin n. <br />ab <br />Aug. 19. 2013 3:13PM NE Secretary of State — UCC No. 0509 P. 2/3 <br />STATE TAX LIEN o NEBRASEA DEPARTMENT OF LABOR <br />• ORIGINAL <br />Employer or <br />Liable Person: I(atherine L Patton <br />Address: 1004 N. Gedde Grand Island NE 68801 <br />NDOL Serial No.: FLAB -0259 -2013 <br />NDOL Acct. No.: 1 0321290003 Hall <br />liederal 1D No. / SSA No.: xxx -xx -8231 <br />Date August 19, 2013 <br />T :\DOCCUMENTSTORMS1Iaens \Original lien.docx <br />RETURN FILED COPIES TO; Nebr. Dept. of Labor - LEGAL <br />P.O. sox 94600 <br />Lincoln, NE 60509-4600 <br />201306788 <br />BY: <br />we sec of Simla J1,., 4 Yale - UCC ST <br />11 0 III 1 11 <br />99 $ - 0 Pos : 1 <br />PATTON KATHERINE L <br />Filed: 08/19/2013 11:02 AM <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 />To be filed with the Register of Deeds in the following Counties: <br />1 <br />This State Tax Lien is issued for unpaid combined taxes (Nab. Rev. Srat 048 -657 and 48 -664) or payments in lieu of contributions (Web. Rev. Slat §48-660,0I) pursuant <br />to the Uniform State Tax lien Registration & Enforcement Act (Neb. Rev. Star. §77 -3901, sr 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 />J t UN IL. 1 , Agency Le Counsel <br />THOMAS A.17KINSKI, Legal Counsel <br />KATIE S. BALTENSPERGER, Legal Counsel <br />1 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 />Commissioner of Labor <br />Ale <br />NEBR. DEPT. OF LABOR <br />CHARGE ACCT. #147645 <br />