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02/06/2001 16:26 FAX 14024714429 <br />NEBRASKA UCC 0 003!003 <br />STL <br />I lillll Iti1111111 I�lll llll111111 III 1111 <br />9901114972 Pss. <br />ARNOLD TROY <br />Filed: 021©5/2901 03.32 PM <br />200100950 <br />NDOL Legal Division <br />STATE TAX LIEN • NEBRASKA DEPARTMENT OF LABOR P.O. Box 94600 <br />Lincoln, NE 68509 -4600 <br />X ORIGINAL Telephone - (402) 471 -9912 <br />FAX - (402) 471 -9917 <br />Emploer Name: Troy Arnold & Bill Diessner d/b /a B & T Concrete & Construction <br />..................... ....................................................................._.................... ..I.................................... ....... <br />Address: 3842 W. Old Hwy 30 Sts A Grand Island NE 68803 <br />NDOL Serial No.t LAB- 0018 -2001 To be filed with the Register of Deeds in the following Counties: <br />.......................................•;............................................. ............................... •.............................-.................................--.........................................,......•.......... ............................... <br />NDOL Employer Acct. No.: 0276635006 Hall <br />.._ ............ ..................... ........ .. ................................... ...................................... ...............................................................,................. ..i.......- ...................................... <br />Federal ID No. I SSA No.: 47- 0819750 <br />This State Tax Lien is issued for unpaid combined taxes (Neb. Rev. Stat. §48 -657) orpayments in lieu of contributions (Neb. Rev. Stat. §48- 660.01) pursuant <br />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 <br />of contributions, interest (computed at 1.3% per month), and penalties are due from this employer and remain unpaid after demand. These combined taxes <br />or payments in Iieu of contributions constitute a lien for any and all personal property and real property in the county/counties named, belonging to the <br />employer, whether now owned or hereafter acquired. <br />Combined Tax or <br />Qtr. / Yr. Date Assessed Payment In Lieu Of Contributions Due <br />Interest Penalty <br />Subtotal <br />3/1999 Dec. 14, 2000 S 336.38 $ <br />68.82 i $ 0.00 <br />1 $ <br />405.20 <br />......................... .......... ........................... .I... .....-...............................•......................................... a........•........• <br />I............................•........,........;....... ............................... <br />4/1999 Dec. 19, 2000 $ 356.44 $ <br />4........................... �.........................•....• <br />56.76 S 26.47 <br />...4,.......................... <br />$ <br />a................- <br />439.67 <br />..................... <br />.............. ...•..................;............. . ........................ i .......................................................... <br />1 <br />•..•. <br />i <br />• <br />$ <br />0.00 <br />$ <br />0.00 <br />S <br />0.00 <br />$ <br />0.00 <br />s <br />S <br />0.00 <br />............... .. .................... ;...... - ....................... .......�............ �..........................................-............................-............................. <br />......;..................................; <br />..- ..-- ...................... <br />.. ...... <br />0 .00 <br />..................... -.... ..........:.................... ....... j................... ............................... -... ............................... i........................ . ......... ... ......:....................... <br />. }....... .............................. <br />` <br />S <br />0.00 <br />..................,.................................. ............................... <br />.............................. ....... i .......... ............................j.. .i......... <br />.......... .;..........- .................................. <br />.............. - ....-- ....- ....... <br />........... <br />! <br />$ <br />0 -00 <br />TOTAL Combined Tax or Payment in Lieu of Contributions Due (under this lien only): $ 844.87 <br />1 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 has failed to pay the amount due after demand. <br />Date: February 5, 2001 <br />FERNANDO CLON <br />Camissioneof <br />BY: <br />H. ALH <br />ncy Legal Counsel <br />NEBR. DEPT. OF LABOR It <br />CHARGE ACCT. #14765 <br />