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NDOL Serial No-: <br />LAB- 0089 -2015 <br />To be tiled with the Re .- of Deeds In the follow : Counties: <br />NDOL Acct. Nat <br />0334798002 <br />Hall <br />2/2014 <br />Federal D No. / SSA No.: <br />mac v(4231 <br />$0.00 <br />$169.00 <br />/ Yr, <br />Data Assessed <br />Combined Tax Or Payment In Lieu <br />Of Contributions Due <br />Penalty <br />Interest <br />Through <br />4/25/2015 <br />Subtotal <br />2/2014 <br />4/10/2015 <br />$1,279.07 <br />$0.00 <br />$169.00 <br />$1,448.07 <br />3/2014 <br />4/1012015 <br />$232.69 <br />$0.00 <br />$20.19 <br />$ 252.88 <br />5 o.00 <br />s o.00 <br />M ' <br />$ 0.o0 <br />s o.00 <br />$ o.00 <br />$ 0.00 <br />$0.00 <br />$ 0.00 <br />$0.00 <br />$ 0.00 <br />TOTAL Combined Tat or Payment iu Lien of Contributions Due (under this lien only): <br />$1,700.95 <br />May , <br />2015 2:53PM NE Secretary of State - UCC <br />201502779 <br />STATE TAX LIEN 0 NEBRASKA DEPARTMENT OF LABOR <br />■ ORIGINAL <br />Employer or <br />Lifsbk Person: Katherine L Patton <br />Address: 3S56 Dr. Tema gton Beach CA 92649 <br />No. 05H . P. 2./4 <br />Ta !as cor Nate John It (fate - ucc an <br />11111111 <br />9915753424 -4 Pas: <br />Filed: K d: 06 IIa L <br />l e11:oz FM <br />NDOL Mee of Legal Counsel <br />P.O. Kos 94600 <br />Lincoln, NE 68509-4600 <br />Telephone - (402) 471 -9912 <br />FAX - (402) 471 -9917 <br />This State Taft Lien is issued for uapnid eambined hum (Nab. Ray. Sant §148-657 and 48.664) or payments in lieu of eomtnbutioor ( Web. R. Star ¢48- b60.01) jammed In <br />the Uniform State Tax Lien Registration & Enforcement Act (Neb. Rev. Short §77.3901, et se f.). Notice is given that combined nixes or payments in lieu of coehibetions, <br />interest (oomp.ted at 1.5% per math), end penalties are dee from skis employer ea peRea end remain umplid alter demon& These combined trees or pageuatos in lieu of <br />cominhutions constitute s lieu for any and all personal p upesty and real property in the county /cwmties named, belonging to the employer er person, whether now owned or <br />hereafter scoured. <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 H. ALBIN <br />Commissioner of Labor <br />Date: May 1, 2015 <br />T :ID000MlIYV7SWOSMS\L►eadlOrigmd lieadous <br />RETURN FILED COPIES TO: Nebr. Dept of Labor - LEGAL <br />P.O. Bra 9400 <br />Laeolq NE 88519-0600 <br />THOMAS A. ZJ I i al Camel <br />KATIE S. TEMBEP., Legal Counsel <br />NEBR. DEPT. OF LABOR <br />CHARGE ACCT. #14765 <br />