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Aug. 5. 2015 2:25FM NE 5e,ratary of Stat — UCC STATE TAX LIEN o NEBRASKA DEPARTMENT OF LABOR • ORIGINAL Qtr. / Yr. Date Assessed I Combined Tax Or Payment In Lieu Of Contributions Due 3/2014 7/10/20)5 � i 4/2014 � 7/10/2015 I Employer or Liable Person: Grupe Construction Address: 7500 Sky Park Rd. Grand Island NE 68801 NDOL Acct. No.: ! 0362526003 Hall —±- - I i - i i Date: August 5, 2015 By: RETURN FILED COPIES TO: Nebr. Dept of Labor - LEGAL P.O. Box 94600 Lincoln, NE 68509.4600 201 505323 TOTAL Combined Tax or Payment in Lieu of Contributions Due (under this lien only): NI to of Penalty $9180 ; $25.00 $0.00 1 $ !Vo. 2104 F. 5 7 Skate John A 6.1A - UCC STL 9915758979 —e Pgs: GRUPE CONSTRUCTION F1iad. 08/0512015 01:49 PM NDOL Office of Legal Counsel P.O. Box 94600 Lincoln, NE 68509 -4600 Telephone - (402) 471 -9912 FAX - (402) 471 -9917 NDOL Serial No.: ; LAB - 0159 -2015 To be filed with the Register of Deeds in the following Counties: Federal ID No. / SSA Na 46- 3968840 This State Tax Lien is issued for unpaid combined taxes (Neb. Rev. Star. § §48 -657 and 48 -664) or payments in lieu of contributions (Neb. Rev. Stat. §48- 660.01) pursuant to the Uniform State Tax Lien Registration & Enforcement Act (Neb. Rev. Stat. §77-3901, at leg.). 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 or person 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 or person, whether now owned or hereafter acquired, Interest Through 7/25/2015 $12.08 $0.00 4 Subtotal $ 128.88 $ 25.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 153.88 I certify that the Nebraska Department of Labor has complied with the Employment Security Law of the State of Nebraska in the determination of the amount due, and the employer or person has failed to pay the amount due after demand. JOHN U. ALBIN' Commissioner of Labor THOMAS A. UKINSKI, Legal Counsel T: 1DOClJ 'MENTStFORMSULiens\Original licn.docx KATIE S. THURBER, Legal Counsel NEBR. DEPT. 01? LABOR CHARGE ACCT. #1.47654)