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Aug. <br />2414 2:00PM NE Secretary of State — UCC <br />S TATE TAX LIEN ❑ NEBRASKA DEPARTMENT OF LABOR <br />• ORIGINAL <br />Employer or <br />Liable Person: Katherine Patton <br />Address: 3886 Montego Drive TfTtntington Beach CA 92649 <br />NDOL Serial No.: LAB -0l63 -2014 <br />NDOL Acct. No.: E 0334798002 <br />Federal ID No. / SSA No. :1 mC xx 4035 <br />Qtr.1 Yr. Date Assessed <br />112014 <br />Date: August 1, 2014 <br />7/11/2014 <br />T- 1DOC1JMENTSWORMS1LieerslOriginal Kea.riocx <br />20 404754 <br />To <br />1x11 <br />By: <br />be <br />Combined Tax Or Payment In Lieu <br />Of Contributions Due <br />TOTAL Combined Tax or Payment in Lien of Contributions Dare (trader this lien only): <br />No. 6014 P. 2 <br />X E Elm of Simi. Id, R U I - UGC ETL <br />993478979E -1 Pea: 1 <br />0A11aN KPTilcRIhE <br />Filed: S51e1I2t114 01.45 PM <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 />Sled with the er of Deeds in the following Counties: <br />This Stsec Tax Lien is issued for unpaid combined taxes (Neb. Rev. Star. 1$48437 and 411.664) or payments in lieu of contributions (Neb. Rev. Shat. 0411-660.0 I) pursuant to <br />the Uniform 5tate Tax Lien ReEistiation & Enforcement Act (Neb. Rev. Stat 177 -3901, et seq.). Notice is given that combined taxer or payments in lieu of contributions, <br />interest (computed at 1.5% per month), and penalties are due from this employer or person and remain unpaid alter demand. These combined taxes or payments in lieu of <br />contributions constitute a lien cur any and all personal property and real property In the co counties named, belonging to the employer or person, whether now owned or <br />hereafter acquired. <br />$2,957.72 1 $0,00 <br />Interest <br />Penalty Through <br />7/26/2014 <br />jdCZ <br />3126.86 <br />OMAS A. U e t e Legal Cou set <br />KATIE S. THURBER, Legal Counsel <br />Subtotal <br />$3,084.58 <br />$ 0.00 <br />$ 0.00 <br />_ -= ..0.00.=_= <br />$ 0.00 <br />$ 0_o0 <br />S 0.00 <br />$ 0.00 <br />$ <br />0.00 <br />$ 0.00 <br />$ 0.00 <br />$3,084.58 <br />I certify that the Nebraska Department of Labor has complied with the Eutployment 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 />JOHN H. ALBIN <br />Acting Commissioner of Labor <br />RETURN PILED COPIES TO: Nebr. Dept. of Labor - LEGAL NEBR. DEPT. OF LABOR <br />P.O. nee $e60o CHARGE ACCT. #14765 <br />Linage, NF 68509.4600 <br />