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�-' Qtr.1 'Yr. <br />Date Assessed <br />Combined Tax Or payment In Lisp <br />Of Contributions Due <br />— - — <br />Penalty <br />Interest <br />Through <br />5/31/2014 <br />Subtotal <br />4/2013 <br />5/16/2014 <br />$1,119.58 <br />$54.46 <br />$66.23 <br />81 .24027 <br />1/2014 <br />5/16/2014 I $2,253.31 <br />50.E <br />$2,287.75 <br />$0.00 <br />$ 0.00 <br />$ 0.00 <br />L <br />$0.00 <br />$ 0.00 <br />$ 0.00 <br />$ 0.00 <br />$0.00 <br />• <br />$ 0.00 <br />$ 0.0o <br />TOTAL Combined Tex or Payment in Lieu of Coatributiana One (under this lien Only): <br />53,521.02 <br />Ds <br />Jun, 6, 2014 1:55FM NE Secretary of State — UCC <br />STATE TAX LIEN o NEBRASKA DEPARTMENT OF LABOR <br />• Oauu iAi. <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 />Employer or <br />Liable Person: To Bmtisers lvlatai Fabrication <br />Address; 104 E. 6 St. Wood River NE 68883 <br />N2 1 403366 <br />Wq sac .f 54.4 &kr:fl Gal■ - UCC ,Tl. <br />Ii I' <br />99147375Oe.2 Poe: <br />To nrmy BROTHERS tETAL FAMRICA <br />Filed: eO10613014 10:12 tiff <br />NDOL Serial No.: LAB- 0125 -2014 ; To be filed with the Register of Deeds in the following Counties: <br />NDOL Acct. No.: 0341488006 Han <br />.r <br />This State Tax Lien is issued for unpaid combined tower (Nab. Rev. Stmt §08-657 and 48 -664) or payments in lieu of contributions (Nd,. key Stat *48- 660.01) pursuant to <br />the 'Uniform State Tax lam Registration & Enforcement Act (Nab. Rev. Sat §17 -3901, ea eq.), Notice is given that combined taxes or I,aaymeuts in deu of contributions, <br />lutenist (computed at 1.5% per month). and penalties arc due from this employer or person and =Aid unpaid after demand. Thom combined taxes or payments in lieu of <br />contributions constitute a lien for any and all personal peopaty and reel property in the county /counties naiad, belonging to dm employer or person. whether now owned or <br />hercafta acquired <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 du; and the employer or person has failed to pay the amount die after demand. <br />CAVE D. LANG <br />Commissioner of Labor <br />Date: rune 6, 2014 <br />T:1 17OCf ]1ltEbl7SWORMS1LidaslOriginal lien.docx <br />RETURN F11ED COPIES TO Nebr. Dept. of Labor - LEGAL <br />P.O. Box 546$ <br />li.eoln, 68509 -4400 <br />JO ' H. ALBIN, Agency l Coustsel <br />THOMAS A. TVKINSIf1; Legal Counsel <br />KATIE S. BALTENSPERGER, Legal Counsel <br />NEER. DEPT. OF LABOR <br />CHARGE ACCT. #147710 <br />