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11/21/2000 11:57 FAX 140.24714429 NEBRASKA UCC Q002/002 NE I Ill5{1 Iflll Illli Illll Ili11111111111?II[ 9900097908 Pot: I HQPKEN MATTHEW H. Flied, 11!21/2000 10:37 RM 200010144 STATE TAX LIEN* NE13 RASKA DEPARTMENT OF LABOR NDOL Legal Division P.O. Box 94600 Lincin, NE 68509 -4600 X ORIGINAL Telephone - (402) 471 -9912 FAX - 402 471 -9917 Employer Name: Matthew H. Hopken d/b /a Mats Quality Detailing _ ............ ........ ................................................. ..............................I ........ I ......................... _ ..... Address: 1037 S. Pine Avenue Grand Island WE 68801 NDOL Serial Noa LAB -0480 -2000 To be filed with the Register of Deeds in the following Counties: .............. .........................................._...__..._............................,................. ............................... NDOL Employer Acct. No.: 0277064000 Hall _.............. i .............. ............................... ......... . .........................................................»......................... .._.._.................,....... i . Federal ID No. I SSA No.: 47. 0815180 This State Tax Lion is issued forunpaid combined taxes (Neb. Rev. Slat. 448 -637) or payments in lieu of contributions (?Veb. Rev. Stat. §48- 660.01) pursuant to the Uniform State Tax Lien Registration & Enforcement Act (N- 5. Rev. Stag. §77 -3901, et seq.). Notice is given that combined taxes or payments in lieu of contributions, interest (computed at 1.5% per month), and penalties are due from this employer and remain unpaid after demand. These combined taxes or payments in lieu of contributions constitute a lien for any and all personal property and real property in the county /counties named, belonging to the employer, whether now owned or hereafter acquired. Combined Tax or Qtr. / Yr. Date Assessed Payment In Lieu Of Contributions Due Interest Penalty Subtotal 1 /1999 October 20, 2000 i $ 34.715 $ 9.23 S 25.00 $ 66.98 » ........ ....... .................. :............................ ......... i.........-..................................... ,.......................... . ... - ....... . .... ................... . ........ s.................................. .... 2/1999 i October 20, 2000 ` S 114.55 i $ 25.24 $ 25.00 S 164.74 3 /1999..............October 20, 2000 .s.. ..._ ................ ............................... 58.16 .. ! $ .........,.....10.18 :..,...$...............25.00 .. $...................93.34.... S 0.00 ....... .............................., ..............................................»............................................................................,..................... .............................., .........» ...... ...... . $ 0.00 S 0. a.......................» .......... ............................... .......................... ............................... .................................,................................ ..,...........................0 ...... ............................... . 0.00 t t ........ .... .............. ... ......_..._.................. ..,.._......................... �.. }..............,............., } ......................... s g 0.00 ...... ............................... i......................... ......... . j,.................».......................•....... ....................- ,..�...... ........�.................... . ;... ,......................0.00... - TOTAL Combined Tax or Payment is Lieu of Contributions Due (under this lien only): '•. $ 327.11 I certify that the Nebraska Department of Labor has complied with the Employment Security Law of the State of Nebraska in the determination of the amount due, and the employer has failed to pay the amount due after demand. Date: November 21, 2000 FERNANDO LECUONA, III Commissioner of Labor By: JOHN F. SHEAFF =or JOHN H. ALBIN Agency Legal Counsel Legal Counsel NEBR. DEPT. OF LABOR CHARGE ACCT. #14765