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<br /> 78- ��O0072
<br /> GERALD E. CHIZEK, ) Certificate of Lien
<br /> Commissioner of Labor, ) or De in uent
<br /> I ) Unem.ployment nsuranc'e Contributions
<br /> vs. )
<br /> )
<br /> Bradly Epstein, a/k/s Brad )
<br /> Madrid, d/b/a HOMBRES, )
<br /> Employer Account Number )
<br /> 83478-008-5733 )
<br /> TO WHOM IT MAY CONCERN:
<br /> The undersigned James R. Jones, attorney for Gerald E.
<br /> Chizek, the duly appointed, qualified, and acting Commissioner of
<br /> Labor of the State of Nebraska, does hereby certify that Bradly
<br /> Epstein, also known as Brad Madrid, doing business as Hombres, doing
<br /> business in Grand Island, Hall County, Nebraska, is indebted to the
<br /> Unemployment Compensation Fund of the State of Nebraska for contri-
<br /> butions due on his employment for the first, second, third, and
<br /> fourth quarters of 1976 and the first quarter of 1977 in the sum of
<br /> S67d.s6, and interest in the sum of 588.08, with interest at the
<br /> rate of one per cent per month on the sum of S674.46, from January 3,
<br /> 1978..
<br /> By reason thereof, said Gerald E. Chizek, as Commissioner
<br /> of Labor, on behalf of the Unemployment Compensation Fund, hereby
<br /> claims a lien in the sum of 5762.54, with interest at the rate of
<br /> one per cent per month on the s�m of 5674. 46, from January 3, 1978,
<br /> until paid, upon any and all property, real or personal, of said
<br /> Bradly Epstein, subject only to liens of prior record pursuant to
<br /> Section 68-657, R.R.S. , Nebr., 1943.
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<br /> ;r� : �7t r 7 �c� �� �1�}�c"t J
<br /> �1ES R. JONES '
<br /> ` ATTORNEY FOR
<br /> GERALD E. CHIZEK, COMMISSIONER OF LABOR
<br /> January 3, 1978
<br /> STATE OF NEBRASKA )
<br /> ) ss.
<br /> LANCASTER COUNTY )
<br /> James R. Jones, being first duly sworn upon his oath,
<br /> deposes and says that he is attornel for Gerald E. Chizek, Commissioner
<br /> of Labor of the State of Nebraska; that he is authorized to make the
<br /> above certificate; that the facts set out above are true and correct.
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<br /> � /.Z_ �i-7' t�
<br /> James R. nes
<br /> SUBSCRIBED in my presence and sworn to before me this 3rd
<br /> day of January, 1978.
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<br /> ' � Notary Pu61ic
<br /> SEAL �A.�usf , ! , �
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