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Qtr. /Yr. i Date Assessed <br />.. .. <br />Combined Tax Or Payment In Lien <br />Of Contributions Due <br />Penalty <br />1 _ Interest <br />Through <br />Wu <br />Subtotal <br />14 / 2 ! 9/17/2014 <br />$150.75 <br />$0.00 $0.00 <br />$ 150.75 <br />$ 0.00 <br />$ 0.00 <br />- <br />e <br />$ 0.00 <br />$ 0.00 <br />! <br />l <br />$ 0.00 <br />$ 0.00 <br />. <br />$0.00 <br />$ 0,00 <br />$ 0.00 <br />$ 0.00 <br />S 0,00 <br />TOTAL Combined Tax or Payment in Lieu of Contributions Due (under this lien only): <br />S 156.75 <br />Lf3 <br />Nov. 4. 2014 3:42PM NE Secretary of State — UCC <br />201407035 <br />STATE TAX LIEN o NEBRASKA DEPARTMENT OF LABOR <br />• ORIGINAL <br />Employer or <br />Liable Person: Johnson Cash Way Lumber <br />Address: 2130 N. Webb Road, Grand Island, NE 68803 <br />NDOL Serial No.: i LAB - 0201-2014 To be tiled with the Register of Deeds in the following Counties: <br />NDOL Acct. No.: I 0008774005 LYall <br />Federal ID No. / SSA Na.: <br />This State Tax Lien is issued for unpaid combined taxes Web, Rev. Sta t. H48 -657 and 48-664) or payments in lieu of oon:ritutic as (Nab. Rev. Stec (41- 660,01) pursuant to <br />the Uniform State Tax Lacs Registration & enforcement Asst (Mb. Rev, Surf. §77390l. it seg.). Notice is given that combined taxes or peamenls in Lieu of contribution, <br />interest (computed at 1.5% pin month), and penalties are due from this employer or parsers aid rerun unpaid after demand, These combined rases or payments in lieu of <br />contributions constitute a lien for any end all personal property and real property in the county /counties named, belonging In the employer or person, vrbether now owned or <br />hcreafta 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 due, and the employer or person has faded to pay the amount due after demand. <br />JORN IL ALBIN <br />Acting Commissioner of Labor <br />Date: November 4, 2014 By: <br />RETURN FILED COPIES TO: Nebr. Dept. of Labor - LEGAL <br />P.O. Box 44608 <br />Lincoln, NE 685094600 <br />T9ROMAS A. UKIONSKI, Legal Counsel <br />L :\General CormsehtegalMOCJt mNTS\Licns\Statc Teat Licns100 00000 000\00 KATIE S. TEIURBRR, Legal Counsel <br />08774 005.docx <br />No, 7494 P, 3/8 <br />Iii See .4 7 {ahe John S Gel. - unc STL <br />1111111 <br />3914144 Psa: I <br />F lied 1111y/ API <br />NDOL Office of Legal Counsel <br />A.O. Box 94600 <br />Lincoln, NE 68509 -4600 <br />Telephone - (402) 471 -9912 <br />FAX - (402) 471 -9917 <br />NEBR. DEPT. OF LABOR <br />CHARGE ACCT. #14765 <br />