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Qtr. /'1(r. <br />Date Assessed <br />-,. <br />Combined Tax Or Payment In Lieu <br />Of Contributions Due <br />Penalty <br />Interest <br />Through <br />6/24/2016 <br />Subtotal <br />01/2015 <br />6/9/2016 <br />51,253.79 <br />$0.00 <br />$736.04 $1,989.83 <br />02/2015 <br />6/9/2016 <br />$761.16 <br />552.88 5123.46 $ 937.50 <br />01/2016 <br />6/9/2016 <br />$1,338.88 <br />$0.00 536.30 i 51,375.18 <br />5 0.00 <br />$ 0.00 <br />MEM $ 0.00 <br />IIIIIMIIIMIIIIINIIIIIIIIIIIIIMIIMIMMIIIMMMIIIIII <br />5 0.00 <br />$ 0.00 <br />IIIMIIIIIMMIIIIIIIIIIIIIIIIIIMMMIIMIIIIIMMIIIIIIIII <br />$ 0.00 <br />5 0.00 <br />5 0.00 <br />5 0.00 <br />TOTAL Combined Tax or Payment in Lieu of Coutributioua Due (under this lien only): S4,302.51 <br />Jul. 5. 2016 3:01FM NE Secretary of State — UCC No. 7250 F 3,,-,_ <br />Nit sew <br />,rs.- . 11111 1 111 <br />201604143 <br />991677 -7 <br />PRTTON KATHERINE L. <br />Filed: W./ME/2016 02:00 PMT <br />STATE TAX LIEN ❑ NEBRASKA DEPARTMENT OF LABOR <br />i 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 />Date: 7/5/2016 <br />Employer or. <br />Liable Person: Katherine L Patton <br />Address: <br />NDOL Serial No.: <br />NDOL Acct. No.: <br />Federal ID No. / SSA No.: <br />1201 Allen Drive, Suite 101 Grand Island, NE 68803 <br />LAB -0062 -2016 <br />0334798002 <br />ma-xx -8231 <br />To be filed with the Register of Deeds in the following Counties: <br />Hall i <br />This State fax Lien is issued for unpaid combined taxes (Neb. Rev. Scat § §48 -657 and 48 -664) or payments in lieu of contributions (Neb. Rev. Star §48 660.01) pursuant to <br />the Uniform State Trot Lien Registration & Enforcement Act (Web. .Rev. Stat. §77 - 3901, et seg.). Notice is given Bret 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 aequiircd. <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. ALI3IN <br />Commissioner of Labor <br />T:\DOCUMEN 0 RMS\l,iens \Original lien.dowt <br />RETURN FILED COPIES TO: Nebr. Dept. of Labor - LEGAL <br />P.O. Box 94600 <br />Lincoln, NE 68509.4600 <br />By: <br />KATIE S. THURBER, Agency General Counsel <br />THOMAS A. UIC NSKI, Legal Counsel <br />DALE M. SHOTKOSKI, Legal Counsel <br />NEBR. DEPT. OF LABOR <br />CHARGE ACCT. #14765 <br />