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NDOL Serial No.: <br />LAD- 0077 -2014 <br />To be flied with the Register of Deeds in the following Counties; <br />NDOL Acct. No.: <br />0334798002 <br />Hall <br />1/2013 <br />Federal YD No. / SSA No.: <br />xxx -xx -8231 <br />$0.00 <br />$8524 <br />Qtr. ( Yr. <br />Date Assessed <br />Combined Tax Or Payment In Lieu <br />Of Contributions Due <br />Penalty <br />F <br />Ot Q erest <br />4/9/2014 <br />Subtotal <br />1/2013 <br />3/25/2014 <br />$428.77 <br />$0.00 <br />$8524 <br />$ 514.01 <br />2/2013 <br />3/25/2014 <br />$2,875.70 <br />$76.27 <br />$357.27 <br />, $3,309.24 <br />. ' 3/2013 <br />3/25/2014 <br />.$2,999.25 <br />$0.00 <br />$236.58 <br />$3,235:83 <br />4/2013 <br />3125/2014 <br />$1,526.78 <br />$0.00 <br />$51.18 <br />$1,577.96 <br />$ 0.00 <br />$ 0.00 <br />V 0.00 <br />$ 0.00 <br />$ 0.00 <br />(r <br />$ 0.00 <br />$0.00 <br />$0.00 <br />TOTAL Combined Tax or Payment in Lieu arContributions Due (ander this lien only): <br />$8,637.04 <br />Apr, 24, 2014 3:43PM NE Secretary of State — UCC <br />rit TAX LIEN a NEBRASKA DEPARTMENT OF LABOR <br />• ORIGINAL <br />Date: April 24, 2014 <br />Employer or <br />Liable Person; Katherine Patton <br />Address: 3886 Montego Drive Hue Beach CA 92649 <br />This State Tex Lim is issued for unpaid combined twee (Neb. Rey. Stat. §§48 ad 4$ -664) or payments in lieu oho utiora (Neb. Rev. Star §48.660.01) pursuant to <br />the Uniform Stair Tax Lien Registration & Enforcement Art (Neb. Rev. Sat. 177 -3901, d seq.). Notice is given that combined bates or peyraccia in licu of contributions, <br />interest (computed at 1.5% per month), and penalties are due from this employer or person and .amain unpaid after demand These combined tmcrs or payments in licu of <br />contributions constitute a lien for any and all person+l property and real property in the oauntykowtties named, belonging to the employer or person, whether now owned or <br />hereafter acquired. <br />Y 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 LObQ1 � <br />T :\DOC MENT 5 1FORMSSLienslOrtglnallien.doci <br />RETURN FILED COPIES TO: Nebr. Dept. of Labor - LEGAL <br />P.O. Hen 94600 <br />Lineoli, NE 6tts09 -4600 <br />By: <br />. No. 4464,.. _P. 3/6 <br />9914734SW -9 POs: 1 <br />PATTON Filed: KATHERINE <br />Filed: 04424/2014 10:62 AM <br />20402450 <br />NDOL Office of Legal Counsel <br />P.O. Box 94604 <br />Lincoln, NE 68509 -4600 <br />Telephone - (402) 471 -9912 <br />FAX - (402) 471 -9917 <br />Legal Counsel <br />A. DYCINSX], Legal Counsel <br />S. BALTENSPERGEB, Legal Counsel <br />NEBR. DEPT. OP LABOR <br />CHARGE ACCT. #14765, v <br />