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NDOL Serial No,: <br />LAB -0064 -2018 <br />To be filed with the Register of Deeds in the following Counties: <br />NDOL Acct. No.: <br />0389682000 <br />Hall <br />04/2017 <br />8/2.2/2018 <br />Federal ID No. / SSA No.: <br />xxx -xx -6710 <br />$119.50 <br />$1,251.46 <br />Qtr. / Yr, <br />Date Assessed <br />Combined Tar Or Payment In Lieu <br />Of Contributions Due <br />Penalty <br />Interest <br />Through <br />9/7/2018 <br />Subtotal <br />04/2017 <br />8/2.2/2018 <br />$1,106.84 <br />$25.12 <br />$119.50 <br />$1,251.46 <br />$ 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 />$ 0.00 <br />$ 0.00 <br />TOTAL Combined Tax or Payment in Lieu of Contributions Due (under this lien only): <br />$1,251.46 <br />S p.12.2013 .):10FM NE ..:ret.ry of State <br />STATE TAX LIEN 0 NEBRASKA DEPARTMENT OF LABOR <br />■ <br />ORIGINAL <br />Employer or <br />Liable Person: <br />Address: <br />Date: September 11, 2018 <br />Timothy R. Enck <br />T \DOCUMENfSWORMS\Liens \Original lien.docx <br />1016 W Koenig Street Grand Island, NE 68801 <br />By: <br />NI Lac of L1e4a Jahn N Gala - <br />I <br />9916819368 -3 <br />ENCK TIMOTHY R <br />Filed: 09/12/2018 <br />2 018 0 6 925 8 <br />10:54 PM <br />KATIE S. T' ' :ER, Agency General Counsel <br />THOMAS A. UKINSKI, Legal Counsel <br />LIBBY ELDER, Attorney <br />UCC sTL <br />Psis: <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 />This State Tax Lien is issued for unpaid combined taxes (Neb. Rev. Start. § §48 -657 and 48.664) or payments in ice of contributions (Neb. Rev. Stat. §48- 660.01) pursuant to <br />the Uniform State Tax Lien Registration & Enforcement Act (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% 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. ALBI . <br />Commissioner of Labor <br />NEBR. DEPT. OF LABO <br />RETURN FILED COPIES TO: Nebr. Dept. of Labor - LEGAL <br />P.O. Box 94600 CHARGE ACCT, #14765 <br />