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11/28/2001 16:16 FAX 14024714429 NEBRASKA UCC Q002/002 <br />rJ� <br />0 <br />200112208 <br />Mr sus e: fiai• - UCC %7L <br />B9A11799 3 -2 Pas: <br />H 6 H CONSTRUCTION <br />Filed: 11/28/2001 10:21 AM <br />STATE TAX LIEN • NEBRASKA DEPARTMENT OF LABOR NDOL Office ofLegal Counsel <br />P.O. Box 94600 <br />Lincoln, NE 68509 -4600 <br />X ORIGINAL Telephone - (402) 471 -9912 <br />FAX - 402 471 -9917 <br />Employer Name: H & H Construction <br />................................................................................................................................................................................................................................................ ............................... <br />Address: 402 Sunset Doniphan NE 68832 <br />NDOL Serial No.: LAB - 0224 -2001 To be filed with the Register of Deeds in the following Counties: <br />................. ............................. . ........................................................... .. ...................... .............. ...... ............................................................................. ........................................... .... <br />NDOL Employer Acct. No.: 0286391009 Hall <br />................................................................................................. ............................... ........... I........................................................... I ......... .... ...... ................................................ <br />: <br />Federal ID No. / SSA No.: <br />This State Tax Lier is issued for unpaid combined taxes (Neb. Rev. Stat. §48 -657) or payments in lieu ofcontributions (Neb. Rev. Stat. X48- 660.01) pursuant <br />to the Uniform State Tax Lien Registration & Enforcement Act (Neb. Rev. Slat. §77 -3901, et seg.). Notice is given that combined taxes or payments in lieu <br />of contributions, interest (computed at 1,50% per month), and penalties are due from this employer and remain unpaid after demand. These combined taxes <br />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 <br />employer, whether now owned or hereafter acquired. <br />Combined Tax or ` <br />Qtr. / Yr. Date Assessed Payment In Lieu Of Contributions Due `•. Penalty Interest Subtotal <br />2/1999 Oct. 26, 2001 $ <br />22.54 ? $ 25.00 <br />i....... <br />$ 8.07 E S 55.61 <br />. <br />...... ............................... <br />3/1999 <br />d....... .......................... <br />i Oct. 26, 2001 i $ <br />.............. <br />108.15 <br />........................ <br />$ <br />;......................... <br />................. <br />25.00 <br />S <br />....................J.................................. <br />38.71 $ <br />171.86 <br />........... ...:...............I........... <br />4/1999 Oct. 26, 2001 $ <br />94.64 <br />€ $ <br />25.00 <br />$ <br />29.58 $ <br />149.22 <br />......................... <br />...:........ ................. ............. .. ................................................................ <br />..................... <br />;.................................. <br />:............................... <br />...:....................................... <br />1/2000 <br />`: Oct. 26, 2001 $ <br />p............................................................................ <br />93.73 <br />$ <br />25.00 <br />$ <br />;............... <br />25,14 $ <br />143.87 <br />..................I...................................................... <br />.. <br />2/2000 <br />Oct. 26, 2001 $ <br />..........;.................... <br />143.29 <br />i $ <br />:............... <br />25.00 <br />$ <br />31.93 $ <br />200.22 <br />....... ..............................,....... <br />3/2000 <br />............................... p...................................... <br />Oct. 26, 2001 $ <br />...... ....................... .......... .... ..... <br />7.98 <br />'• S <br />:........ <br />..._... ............ <br />25.00 <br />1.................................. <br />': $ <br />♦ ................................... .... <br />1.42 •'. $ 34.40 <br />................................. <br />:....................................... ...................................................................................... <br />.... . ................ <br />;................. <br />,,...:............................. <br />.....:...... .................. <br />$ <br />{........ <br />........... .. <br />0.00 <br />.............. .... .................... ............................................. <br />' <br />1........ <br />.......................................... <br />................. <br />................. <br />................. ............................... <br />` $ 0.00 <br />..... <br />...................................... <br />............................... ............... ......... <br />' <br />$ <br />0.00 <br />......................... I ...... <br />....................................... <br />............................... <br />........................................ <br />.. <br />TOTAL Combined Tax or Payment in Lieu of Contributions Due (under this lien only): $ 755.18 <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 has failed to pay the amount due after demand. <br />Date: November 28, 2001 By: <br />FERNANDO LECUON <br />Gommissi0her of L0bor <br />N H.'-XLBTN -or- THOMAS A. UKINSKI <br />Legal Counsel Legal Counsel <br />RETURN FILED COPIES TO: Nebr. Dept. of Labor- LEGAL NEBR. DEPT. OF LABOR <br />P.o. Box 9.6600 CHARGE ACCT. #147�', <br />Lincoln. NE 69509 -4600 <br />