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Sep. 19. 2014 3:03PM NE Secretary of State - ACC <br />R ORIGINAL <br />Qtr. / Xr. <br />STATE TAX LIEN 0 NEBRASKA DEPARTMENT Olr LABOR <br />Employer or <br />Liable Person: Richard D. Wiseman <br />Address: 103 Beachwood Drive Grand Island NE 68803 <br />NDOL Serial Na.: LAB-0179-2014 To be filed with the Register of Deeds ha the foliowin 9onntiesL <br />NDOL Acct No.: 1 0314836005 Hall ! <br />Federal ID / SSA No.: 1 sxx -xx -6064 <br />This State Tax Lien is issued for unpaid combined taxes (Neb. Rev, Stat. §§48 -657 end 48 -664) es payments In lieu of contributions (Neb. Pelt Suu §48- 660.01) pursuant to <br />the Uniform State Tax Lien Registration & Eaforceanenl Art (Neb. Rev_ Sen. 1773961, et seq.). Notice Is gives that combined taxes 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 />oonmbuthor2 cc sti ute a hen for eny and all personal property and real property in the county/counties panted, belonging to the employer or person, whether now owned or <br />hcreaftea acquired <br />Date Assessed 's <br />s ! <br />i ! <br />Combined Tax Or payment In Lien <br />Of Contributions Due <br />1/2011 8/20/2014 <br />3t2011 8/20/2014 <br />4/2011 8/20/2014 <br />1/2012 8/20/2014 <br />2/2012 8/20/2014 <br />3/2012 8/20/2014 <br />4/2012 8/20/2014 <br />1/2013 8/20/2014 <br />2/2013 8/20/2014 <br />3/2013 8/20/2014 <br />4/2013 ! 8/20/2014 <br />1/2014 j 8/20/2014 <br />TOTAL Combined Tax or Payment in Lieu of Contributions Due (under this pen only): <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 />.IOIiN 1L ALBIN <br />Acting Commissioner of Labor <br />Date: September 19, 2014 <br />T: IDOCUIvIEN151FORMS \Liens106$inal lien.docx <br />RETURN FILED COPIES TO: Nebr. Dept. of Labor - LEGAL <br />P.O. Box 14600 <br />Lincoln. NE 68809 -600 <br />201405960 <br />By: <br />Penalty <br />$0.00 1 525.00 <br />$0.00 $0.00 <br />80.00 $0.00 <br />8315.79 , $0.00 <br />$751.36 1 <br />50.00 <br />8504.41 50.00 <br />No. 6754 P. 4 <br />PHI kfofe John <br />11cC an. <br />59147 421Si_8 <br />Plied: 09/1S/2214 ' D. Paw: <br />12 :33 AM <br />NDOL orrice of Legal Counsel <br />F.O. Box 94600 <br />Lincoln, NE 68509 -4600 <br />Telephone - (402) 471 -9912 <br />FAX (402) 471 -9917 <br />Interest <br />Through <br />9/4/2014 <br />5100.19 <br />$70.13 <br />5111.79 <br />$384.83 <br />$283.37 <br />$167.36 <br />THOMAS A. UKINSK1, Legal Counsel <br />KATIE S. THURBER, Legol Counsel <br />Subtotal <br />$ 125.19 <br />$ 70.]3 <br />$ 111.79 <br />$ 700.62 <br />51,034.73 <br />5 671.77 <br />$86.30 525.00 ! 524.72 ! $ 136.02 <br />5158.17 50.00 $38.37 1 5 196.54 <br />$107.02 525.00 ! $21.10 c 5 153.12 <br />5143.32 t 525.00 $21.76 ! 8 190.08 <br />580.90 $0.00 $8.61 $ 89.51 <br />516.96 58.04 51.06 ! $ 26.06 <br />$3,505.56 <br />NEBR. DEPT. OP LABOR <br />CHARGE ACCT. #14765 <br />