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Qtr, / Xt. <br />i Date As <br />Combined Tax Or Payment In Lieu <br />Of Contributions Due <br />penalty <br />Interest <br />Through <br />8 <br />9/4/2014 <br />Subtotal <br />112011 <br />i 8/20/2014 <br />$0.00 <br />$25.00 <br />$0.00 <br />8100.19 i <br />$ 125.19 <br />3/2011 <br />j 8/20/2014 <br />$0.00 <br />870.13 <br />$ 700.13 <br />412011 <br />! 8/20/2014 <br />50.00 <br />J <br />$0.00 <br />$111.79 ; <br />$ 1E1.79 <br />1/2012 <br />! 8/20/2014 <br />$315.79 <br />$0.00 <br />8384.83 <br />$ 700.62 <br />2/2012 <br />8/20/2014 <br />$751.36 <br />$0.00 <br />$283.37 <br />$1,034.73 <br />3/2012 <br />AJ20/2014 <br />$504.41 <br />$0.00 <br />$16736 f <br />$ 671.77 <br />4/2012 <br />8/20/2014 <br />1 586.30 i <br />S25.00 ! <br />524.72 <br />$ 136.02 <br />1/2013 <br />8/20/2014 <br />8158.17 <br />$0.00 <br />$38.37 i <br />$ 196.54 <br />2/2013 <br />8/20/2014 <br />a $107.02 <br />$25.00 , <br />$21.10 I <br />5 153.12 <br />312013 <br />8/20/2014 <br />? $143,32 <br />52 5.00 <br />$21.76 <br />$ 190.08 <br />412013 <br />8/20/2014 <br />i 580.90 <br />$0.00 <br />$8.61 f <br />$ 89.51 <br />1/2014 <br />8/20/2014 <br />$16.96 <br />58.04 ; <br />$106r <br />$ 26.06 <br />Sep. 19. 2014 3:02PM NE Secretary of State - UCC <br />201405958 <br />STATE TAX LIEN o NEBRASKA DEPARTMENT OP LABOR <br />U ORIGINAL <br />Employer or <br />Liable Person: Grand Island Liquor Mart & Tobacco Row LLC <br />Address: 710 N, I)iers Grand Island NE 68803 <br />NDOL Serial No.: LAB -0180 -2014 To be riled with the Register of Deeds in the following Counties: <br />NDOL Acct. No.: 0314836005 Hall i i <br />Feder] l7) No./ SSA No.: i 39- 1964386 T <br />This State Tax Lien is issued for unpaid combined taxes (Nell. Rev. Scat. § 08-657 and 48 -664) or payments w lieu ofcoatributione (Neb. Rev. Star. $48 -660.01) pursuant to <br />the Uniform State Tax Lien Registration & Enforcement Act (Neb. Rev. Seer. 177 -3901, et seq. ). Notice is given that combined taxes or payments in lieu of contributions. <br />interest (computed at 1.5% per month), and penalties arc due from this catploycr or person and remain unpaid after demand, These combined taxes or payments in lieu or <br />contrbutions constitute a lien for any and all personal property and real property in the county/counties named, belonging to ure employer or person. whether now owned or <br />hereafter acquired <br />TOTAL Combined Tax or Payment in Lies of Contributions Dna (undrdr this lion only): <br />No, 6754 P. 2 <br />11E F-c <br />of SAO* lv1,■ P bil• LICE sYL '.� <br />r,1 IJi'i <br />9814742152 -4 Pas: 1 <br />GRAr10 ISLAM LIt11101 MART i. TOM <br />Filed: 081012014 0:33 Lai <br />NDOL Office of Legal Counsel <br />P.O. Bel 94600 <br />Lincoln, NE 68509 -4600 <br />Telephone - (402) 471 -9912 <br />FAX (402) 471 -9917 <br />53,505.56 <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 due, and the employer or person has failed to pay the amount due after demand. <br />JOHN IL ALBIN <br />Actin Commissioner of Labor <br />THOMAS A. UIUNSKI, Legal Counsel <br />M IDOCUMENTS1FORMS1Liene\Original lien.doex KATIE S. TH URBER, Legal Counsel <br />Date: September 19, 2014 By: <br />RETURN FILED COPIES TO Nebr. Dept. of Labor - LEGAL <br />P.O. Rea 14600 <br />C.iacoia, ]E 68509 -600 <br />NEBR. DEPT. OF LABOR <br />CHARGE ACCT. #14765 <br />i/ <br />