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Qtr. /'fir. <br />Date Assessed <br />Combined Tax Or Payment In Lieu <br />Of Contributions Due <br />Penalty <br />Interest <br />Through <br />3/27/2017 <br />Subtotal <br />02/2016 <br />2/3/2017 <br />$624.78 <br />$46.28 <br />$62.53 <br />$ 733.59 <br />03/2016 <br />2/3/2017 <br />$624.78 <br />$46.28 <br />$34.19 <br />$ 705.25 <br />04/2016 <br />2/3/2017 <br />$624.78 <br />$46.28 <br />55.85 <br />$ 676.91 <br />$ 0.00 <br />$ 0.00 <br />$ 0.00 <br />$ 0.00 <br />$ 0.00 <br />$ 0.00 <br />$ 0.00 <br />$ 0.00 <br />$ 0.00 <br />Mar, 29. 2017 9:04FM • NE Sec eta ry of State — UCC -.• <br />STATE TAX LIEN ❑ NEBRASKA DEPARTMENT OF LABOR <br />ORIGINAL <br />Employer or <br />Liable Person: Grand Island Automotive Inc. <br />Address: 3630 S. Locust Street Grazed Island, NE 68801 -8825 <br />NDOL Serial No,; LAB - 0031 -2017 To be filed with the Register of Deeds in the following Counties: <br />NDOL Acct. No 00 06756 000 Hall <br />Federal ID No. / SSA No.: 47- 0636508 <br />This State Tax Lien is issued for unpaid combined taxes (Neb. Rev. Stat. §§48{57 and 48 -664) or payments in lieu of contributions (Neb. Rev, Stat. §46- 660.01) pursuant to <br />the Uniform State Tax Lien Registration & Enforcement At (Neb. Rev. Stat. §77 -3901, et seq.). Notice is given that combined taxes or payments in lieu of contributions, <br />interest (computed at 1.5 °h per month), and penalties are due from this employer Or person and remain unpaid after demand. These combined taxes or payments in Iicu 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 />TOTAL Combined Tax or Payment hi Lieu of Contributions Due (under this lien only): <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 bas failed to pay the amount due after demand. <br />JOHN H. ALBIN <br />Commissioner of Labor <br />Date: March 28, 2017 <br />TAtiocuMENTS\PO1 MS\Liens\Original lien.docac <br />RETURN FILED COPIES TO Nebr, Dept, of Labor - LEGAL <br />P.O. Boa 94400 <br />201701901 <br />By: <br />i. of 14.t. John A Gala - UGC ET <br />9917789412 -7 Pao: <br />GRAND ISLAND AUTOMOTIVE INC. <br />Filed: 03!28/2017 02 :32 PM <br />N 0212 P. 2 <br />ORONO <br />NDOL Office of Legal Counsel <br />P.O. Bog 94600 <br />Lincoln, NE 68509 -4600 <br />Telephone - (402) 471 -9912 <br />FAX - (402) 471 -9917 <br />KATIE S. THEMBER, Agency General Counsel <br />THOMAS A. UKINSKI, Legal Counsel <br />DALE M. SHOTKOSKI, Legal Counsel <br />NEBR. DEPT. OF LABOR <br />CHARGE ACCT. #14765 <br />