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�. <br />Qtr. / Yr. <br />Date Assessed <br />Combined Taft Or payment In Lieu <br />Of Contributions Due <br />Penalty <br />Interest <br />Through <br />g <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 />$34.19 <br />$ 70525 <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 />$ 0.00 <br />$ 0.00 <br />.Mar.23. 2517 3:05PM, NE ..e_retary .f St — UCC <br />STATE TAX LIEN ❑ NEBRASKA DEPARTMENT OF LABOR <br />A ORIGINAL <br />Employer or <br />Liable Person; Mike A. Kraft <br />Address: 3630 S. Locust Street Grand Island, NE 68801 -8825 <br />NDOL Serial No.: <br />NDOL Acct. No.: <br />Federal ID No. / SSA No.: <br />LAB -0030 -2017 <br />00 06756 000 <br />xxx -lox -1214 <br />201701903 <br />This State Tax Lien is issued for unpaid combined noes (Nab, Rev. .Stat. §14$-657 and 48 -664) or payments in ieu of contributions (Neb. Rev. Stat. §48 -660.01) pursuant to <br />the Uniform State Tax Lien Registration & Enforcement Act (Neb. Rev. Scat. §77 -3901, at seq.). Notice is given that combined taxes or payments in lieu of contributions. <br />interest (computed at 1.5% per month), and penalties arc 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 />hcrcaftcr acquired. <br />TOTAL Combined Tax or Payment in Lieu of Contributions Due (under this li onl y ): <br />To be filed with the Re 'ster of Deeds in the followin Counties: <br />Hall <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 />Date: March 28, 2017 <br />T :WOCUMENfS\FORMSILiens\Original lien,dacx <br />RETURN FILED COPIES TO: Nebr. Dept. of Labor - LEGAL <br />P A ltrn 94400 <br />By: <br />Vc. 5212 <br />NE Sac .1 Slat& Jahn R Gal. - UGC STL <br />11 III" <br />9917789414 -1 Pos: 1 <br />KRAFT NIKE A_ <br />Flied: 03/29/2017 02 ;32 PH <br />J94 <br />KATIE S. THURIIER, Agency General Counsel <br />THOMAS A. UKINSKI, Legal Counsel <br />DALE M. SHOTKOSKI, Legal Counsel <br />NDOL Office of Legal Counsel <br />P.O. Bon 94600 <br />Lincoln, NE 68509 -4600 <br />Telephone - (402) 471 -9912 <br />FAX - (402) 471 -9917 <br />NEBR. DEPT. OF LABOR <br />CHARGE ACCT. #14765 <br />