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Aug. 5. 0015 2:25PM NE Eucre.tary 'Stat. — UCC <br />STATE TAX LIEN 0 NEBRASKA DEPARTMENT OF LABOR <br />■ ORIGINAL <br />NDOL Office of Legal Counsel <br />P.O. Box 94600 <br />Lincoln, NE 68509 -4600 <br />Telephone - (402) 471 -9912 <br />FAX - (402) 471 -9917 <br />NDOL Serial No.: z LAD - 0160 -2015 <br />NDOL Acct. No.: i 0340459000 <br />Federal ID No. / SSA No.: xxx- xx-3427 <br />Qtr. / Yr. <br />2/2013 i 7/10/2015 <br />3/2013 ! 7/10/2015 ti <br />4/2013 7/10/2015 r <br />Date: August 5, 2015 <br />Employer or <br />Liable Person: Tara J Graves <br />Address: 2422 W 18 Street Grand Island NE 68801 <br />Date Assessed <br />T'\DOCUty ENTS12ORMS \Liens \Original lien.docx <br />P.O. Box 94600 <br />Lineola, NE 68509 -4600 <br />Of Contributions Due <br />201505321 <br />To be filed with the Re ister of Deeds in the followxn Counties: <br />Hall <br />This State Tax Lien is issued for unpaid combined taxes (Neb. Rev. Stat. § §45 -657 and 48 -664) or payments in lieu of contributions (Neb. Rev. Slat. 148- 660.01) pursuant to <br />the Uniform State Tax Lien Registration & Enforcement Act (Neb. Rev. Star. §77 -3901, et seq.). Notice is given 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 after demand. These combined taxes or payments in lieu of <br />contributions constitute a lien for any and all personal property and real property in the county /counties named, belonging to the employer or person, whether now owned or <br />hereafter acquired. <br />Interest <br />Combined Tax Or Payment. In Lieu <br />Penalty Through <br />7/25/2015 <br />$60197 $36.91 I $270.86 <br />$953.88 $5236 $297.21 <br />M E Sec of 54a a John R aalo • UCC SYL <br />1111- 11 1 <br />9915758978 -4 P9s: 1 <br />GRAVES TARA 3 <br />Filads ®8105/2015 01:49 PM <br />$51721 I $31.31 ' $137.69 <br />___4"___ <br />1 -- <br />, ____„„___ <br />__ <br />i _1_ <br />1 r 1 <br />No. 2104 F. 4,.7 <br />TOTAL Combined Tax or Payment in Lieu of Contributions Due (under this lien only): pp } <br />Subtotal <br />$ 91134 <br />$1,30345 <br />$ 686.21 <br />$ 0.00_ <br />$ 0.00 <br />$ 0.00 <br />$ 0.00 <br />r $ 0.00 <br />$ 0.00 <br />$ 0.00 <br />$ 0.00 <br />$ 0.00 <br />$2,901.40 <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 />. /4 <br />By: <br />THOMAS A, UKINSKI, Legal Counsel <br />KATIE S. THURBER, Legal Counsel <br />RETURN FILED COPIES TO: Nebr. Dept. of Labor - LEGAL NEBR. DEPT. OF LABOR <br />CHARGE ACCT. #14765 �Q , <br />