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Qtr. / Yr. <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 />$5.85 <br />$ 676.91 <br />$ 0.00 <br />$ 0.00 <br />$ 0.00 <br />$ 0.00 <br />$ 0.00 <br />$ 0.00 <br />$ 0.00 <br />- <br />$ 0.00 <br />$ 0.00 <br />Q..1 11e Me <br />Mar. 23. 2017._ :O�F'M : .NE Secretary of State — UCC. <br />201701902 <br />.....Nc.0212.= F. 3 <br />NE Sec o} Stale John A G.1e - U GC 5TL <br />9917789413 -9 Pas 1 <br />KRAFT LORI G. <br />Filed: 03/29/2017 02:32 PM <br />STATE TAX LIEN ❑ 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 />PAX - (402) 471 -9917 <br />TOTAL Combined Tax or payment in Lieu of Contributions Due (under this lien only): <br />Date: March 28, 2017 <br />Employer or <br />Liable Person: Lori G. Kraft <br />Address: 3630 S. Locust Street Grand island, NE 68801 -8825 <br />To be bled with the Register of Deeds in the following Counties: <br />Hall <br />T:\DOCUMENTS\FORMS\liens \Original lien.docx <br />NDOL Serial No.: LAB- 0029 -2017 <br />NDOL Acct. No.: 00 06756 000 <br />Federal ID No. / SSA No,: xxx - toe - 2702 <br />This State Tax Lien is issued for unpaid combined taxes (Neb. Rev. Star. § §48 -657 and 4B -664) or payments in lieu of contributions (Neb. Rsv. Stat. §48- 660.01) pursuant to <br />the Uniform State Tax lien Registration & Enforcement Act (Neb. Rev. Slat. §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 reel property in the county /counties named, belonging to The employer or person, whether now owned or <br />hereafter acuuired <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 />By: <br />yr <br />KATIE S. THURBER, Agen General Counsel <br />THOMAS A. UKTNSKI, Legal Counsel <br />DALE M. SHOTKOSIct, Legal Counsel <br />RETURN FILED COPIES TO; Nebr. Dept. of Labor - LEGAL NEBR. DEPT. ON LABOR <br />P.O. Box 94600 CHARGE ACCT. #1476% <br />