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NDOL Serial No.: <br />I LAB - 0017 -2018 <br />To be filed with the Register of Deeds in the following Counties: <br />NDOL Acct. No.: <br />0288410005 <br />Hall <br />! <br />Federal ID No. I SSA No.: loot -xx -0920 <br />$153.77 <br />I <br />Qtr. / Yr. <br />Date Assessed <br />Combined Tax Or Payment In Lieu <br />Of Contributions Due <br />Penalty <br />Interest <br />Through <br />3/212018 <br />Subtotal <br />02/2017 <br />2/14/2018 <br />$153.77 <br />$0.00 <br />$16.22 <br />$ 169.99 <br />03/2017 <br />2/14/2018 <br />$108.15 <br />$0.00 <br />$6.50 <br />$ 114.65 <br />04/2017 <br />2/14/2018 <br />$42.71 <br />$0.00 <br />$0.63 <br />$ 43.34 <br />$ 0.00 <br />$ 0.00 <br />$ 0.00 <br />$ 0.00 <br />$ 0.00 <br />IIIIIIIMIIIIIIIII=MIIIIIIIII <br />$ 0.00 <br />$ 0.00 <br />IIIMIIIIIIIIIIIIIIMIII <br />$ 0.00 <br />$ 0.00 <br />TOTAL Combined Tax or Payment in Lieu of Contributions Due (under this lien only): <br />$ 327.98 <br />Mar. 7. 2013 4:16PM NE S of State — UCC <br />Employer or <br />Liable Person: <br />Address: <br />Henry A. Rath'en <br />1504 W Ave. Grand Island, NE 68801 <br />20180 <br />1/! 54e of i * -!. John P Gale - U[[ 511. <br />9918307277 - Pus! <br />RRTHJEN HENRY R. <br />Filed: 03/07/2019 02:24 PM <br />N <br />No. 3620 P. 4 <br />STATE TAX LIEN ❑ NEBRASKA DEPARTMENT OF LABOR <br />II 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 />This State 'Cent Licn is issued for unpaid combined taxes (Neb. Rev. Star §§48 -657 and 48 -664) or payments in mu of contributions (Neb. Rev. Stat. §48- 660.01) pursuant to <br />the Uniform State Tax Lien Registration & Enforcement Act (Neb. Rev. Stat. §77 -3901, at seg.). 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 real property in the county /counties named, belonging to the employer or person, whether now owned or <br />hereafter acquired. <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: 3/6/2018 <br />T:\000UMENTS\FORMS\Liea5 \Original Iien.docx <br />RETURN FILED COPIES TO: Nebr. Dept. of Labor - LEGAL <br />P.O. Box 94600 <br />Lincoln, N)B 68509.4600 <br />By: <br />KATIE S. T ' : ER, Agency General Counsel <br />THOMAS A. MINSKI, Legal Counsel <br />LIBBY ELDER, Attorney <br />NEBR. DEPT. OF LABOR <br />CHARGE ACCT. #1476 <br />