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10/19/2005 15:58 FAX 14024714429 NEBRASKA Dee Ig] 0021003 \)~ 200510412 9905417571-9 Pes: 1 QUERING INC. Filed: 10/17/20e6 10:&4 AM STATE TAX LIEN. NEBRASKA DEPARTMENT OF LABOR ~ ORIGINAL NDOL Office of Legal Counsel P.O. Box 94600 Lincoln, NE 68509-4600 Telephone - (401) 471-9912 FAX - (402) 471~9917 Employer Name: Quering Inc. fldlb/a Village Inn '------~~_._-----------~------------- Address: 2624 S. Locust Street Grand Island NE 68801 NDOL Serial No.: LAB-0163-200S To be filed with the Register of Deeds in the following Counties: ~._-_.----~------- ------ -r--- . ~~ NDOL Employer Acct. No.: 0041913002 Hall =+ ---..-------.. ---. .------ ---- ------- Federal ID No.1 SSA No.: ! 47-0526931 I i This State Tax Lien is issued for unpaid combined taxes (Neb. Rev. Stat. ~48-6S7) or payments in lieu of contributions (Neb. Rev. Stat. ~48-660.0 I) pursuant to the Uniform State Tax Lien Registration & Enforcement Act (Neb. Rev. Stat. ~ 77 -3901, et seq.). Notice is given that combined taxes or payments in lieu of contributions, interest (computed at 1.5% per month), and penalties are due from this employer and remain unpaid after demand. These combined taxes or payments in lieu of contributions constitute a lien for any and all personal property and real property in the county/counties named, belonging to the employer, whether now owned or hereafter acquired.. 4/200~__ I ._ 9/28/200~_ 1/2003 ~ 9/28/2005 3/2003 I 9/28/2005 -~~"-~---r--._-~'" $19.14 $31.10 $34.33 $52.91 $62.19 $0.00 Interest Through 10/13/2005 $9.30 $13.75 $12.07 Subtotal Qtr./ Yr. Date Assessed Combined Tax Or Payment In Lieu Of Contributions Due Penalty =-=~=-t-=--- $ 81.35 --.--......-........------ $ 107.04 --.---- $ 46.40 $ 0.00 $ 0.00 $ 0.00 $ 0.00 _.~~~~--+~ $ 0.00 --_.------.~------ .-..----i.-.-...--- : ~:~~.. --_....-.._]~=~--- L!!.O~__ $ 0.00 S 234.79 -.----.--. ___~__ I ____...._.__... ---+-.----- --t--'--- j TOTAL Combined Tn or Payment in Lieu of Contributions Due (under this lien only): , I certify that tbe Nebraska Department of Labor bas complied with the Employment Security Law of the State of Nebraska in the determination oftbe amount due, and tbe employer has failed to pay the amount due after demand. FERNANDO LE A Commissio bo Date: October 17, 2005 By: -or- THOMAS A. UKlNSKI Legal Counsel RETURN FILED COPIES TO: Nebr. Dept. of Labor- LEGAL P.o. Box 94600 l.in~..ln. NF. AA~n9.41i1l1l NEBR DEPT. OF LABOR CHARGE ACCT. #14765 Qf