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NDOL Serial No.: <br />LA13 -0107 -2015 <br />To be filed with the of Deeds in the follower Comities: <br />NDOL Acct No.: <br />0352076008 <br />Hall <br />4/2013 <br />Federal 1D No. I SSA No.: <br />m -7a -1364 <br />825.00 <br />840.76 <br />Qtr. / Yr. <br />Date Assessed <br />Combined Tsui Or Payment In Lieu <br />Of Contributions Due <br />Pence, <br />Interest <br />Through <br />5/24/2015 <br />' <br />Subtotal <br />4/2013 <br />5/14/2015 <br />$171.18 <br />825.00 <br />840.76 <br />$ 236.94 <br />1/2014 <br />5/14/2015 <br />$403.67 <br />$25.00 <br />$78.41 <br />$ 507.08 <br />2/2014 <br />5(14/2015 <br />$82.33 <br />$25.00 <br />812.266 <br />$ 119.59 <br />3/2014 <br />( 5/14/2015 <br />$0.00 $25.00 <br />$0.00 <br />$0.00 <br />$ 25.00 <br />$ 25.00 <br />4/2014 <br />5/14/2015 $0.00 $25.00 <br />1/2015 <br />5/14/2015 $484.40 $25.00 <br />$6.93 <br />$ 516.33 <br />$ 0.00 <br />$ 0.00 <br />$0.00 <br />IIIIOIIIIIIIIIUIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIHIIIIIIMIII <br />S 0.00 <br />$ 0.00 <br />$ 0.00 <br />TOTAL Combined Tai or Payrnost in Lieu of Contributions Dee (under this lien oily): <br />51,419.94 <br />Jun, 4, 2015 3:44PM NE Secretary of State - UCC No. 1146 n• 2/6 <br />STATE TAX LIEN o NEBRASKA DEPARTMENT OF LBOR <br />a O11IGIl'IAL <br />NDOL Office of Legal Counsel <br />P.O. Box 94600 <br />Lincoln, NE 63509 -4600 <br />Telephone - (402) 471 -9912 <br />FAX - (402) 471 -9917 <br />Employer or <br />Liable Person: Mark T f/d/b/i Mark Trac <br />201503725 <br />Address: 643 E Ashton Ave. Grand Islnod NE 68$01 <br />I.. of {i.4/ Jahn 11 Gala - UCC Lit <br />9915755410 -7 Pow: 1 <br />TRRCY MARK <br />Filed; 11510412e15 01:25 PM <br />This Stare Tax lien is issued for unpaid combined tam (Nab. Rev. Stag f448 -657 and 48-664) or payments in lieu of ooa> utioaa (Mb, Rev. Starr §48.660.01) pseauani to <br />the Uniform State fox Una Registration & Lnbprcemeat A,ot (Nab. Rev. Scat §77 -3901. et seq.). Notice is wee that combined farces or payments in liar of contributions, <br />iraaeast (Computed at 1.5% per month), and paialties are due from this employer perm and mania unpaid pans demand. Thane combined taxes or payments in lieu of <br />contributions constitute a lien for any and all personal prmpaty and real property in the coualty/milities named, belonging to tae employer or person, whether now owned or <br />hereafter acquied. <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, end the employer or person lama failed to pay the amount due after demand. <br />JOHN H. ALBIN <br />Commissioner of Labor <br />Date: hue 4, 2015 <br />?: TICOMENTWOMOIWCHOW licadoox <br />RETURN PILED COPIES TO: Nebr. Dept. of Labor - LEGAL <br />P.O. Box MOO <br />Ureoli,NE 68509 -460 <br />ley: <br />• <br />TH a MAS A. UKINSKI, Legal Counsel <br />K 4 TJE S. THURBER, Legal Counsel <br />NEBR. DEPT. OF LABOR <br />CHARGE ACCT. #14765 <br />