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<br /> t�E�U�CC DI�
<br /> '�9 D�C -� kM ��
<br /> s���r sr���
<br /> STATE '�.� LIEN i NE$RASKA DEPART?VIENT�UF LABOR NDOL Le� �
<br /> P.O��*
<br /> I�mcoin,NE �899��
<br /> �URlGINAL Telcphona-{qOS)471�� '
<br /> FAX-�40Zj 471-5�17
<br /> �mployer Nsme: CHILDRENS FIIZST DA'YCARE CENPER
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<br /> Addrese: 1323 N.L,af�yetm Avenue, Grand Island,I�68803
<br /> �L Serial No�� i.?,B-0338-1999 To b�P�led with lhsitegi�ter o#Aeed�tn the tollowin�Cou�ltle9�
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<br /> NDOL Ert�ployer Aoct,No.; 026311 l003 HaII '•
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<br /> Fed�nl ID No./SSA No.: 47•4 i 98752
<br /> 'Thie 5r�Tax Linn i9 issu�d fox uslpsi3 Combilled t�7ce8(Ngb-Rev.Staf- Q4�-d3'7)or paymesnt�in fieu of mntributions(Nab.�feu.Stat.g48•660,01)pursuant
<br /> to the Uniform S+ate'i�ac Lien Regi�tration dt Enforoement Aot(Neb,Rev,Stat,§77-3901,et seq.). Narica is givon that combin�d taxes ar p�+mwtt�in liaeu
<br /> of oontr�budana,ime�rst(comgutod at 1.5°r6 per�+c�th},and penalNea are due fram thia employer end eemsin unpaid af�er deteand. These oombined t3xes
<br /> or paym€nts in tiev of contri�utions constitute a lian£or eny anC a11 personal properry and real property in thn eaunty/oounpes nemed,beloa�ing co t3�e
<br /> emplay�,whnthar naw owned or heraaRer aaqui�d.
<br /> � ' Combinod Tsx or ' �
<br /> Qtr,/Yr. ' Date Assassed ; P�yment Yn Lieu Of Cantributions � Interoat ? Penal#y j B�btotai
<br /> � Duc �
<br /> ' � ; � � �
<br /> 4-1997 7-14-99 � $ �59.32 � $ ... 67.68 ; � 0.00 � � 327.2Q
<br /> ....�.,.....1-1998,...,....p, .,...,..'�14•94 � '..c...�................................,.......a........,.,,,.,...,...381,19..=...$.. �-�- ��g2.59.......�...........�.00..;...�..,.....,.,...48�,88 ..
<br /> ,.....,,....a_�998..........:.........,-1 A•99.........i...S...........,.,. ..._...........................,...........133.42..:...�............�2.89,.�...�.............25.pp..�..�.,,..,.......1$1.3 Z...
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<br /> ' ' ; ' $ 0,00
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<br /> ....................................�._. , ....................,.;,.,...,...........,.,.....,,...,....,.,........,....,. ..._...................,... ' ...............................;.............................,..�...�..................0.00...
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<br /> .....,..... ...
<br /> � � = E � $ O.Rp
<br /> 'C�'�AL Camblaed Tax or Pay�nent In Lleu at Cuntributione Due(under thia lien only): � $ 937,39
<br /> i certify thaE th�NobrnsltA Dep�rtment of L9bor his epmpltes rvlth the Em�loyment Securtty Law of the 3tsle of Tiebrasks ln thc
<br /> deterrnination of the amou�t due,and the emplo7er hae faited to pay the�mnunt due a�ter demand.
<br /> FER1�iiANDO L�CUONA,III
<br /> Commissioner ef T.aaor
<br /> Dat�; pecembar 6, 1999 By: '
<br /> J�HN F,Sk��AFP -ar- .AL
<br /> Agency�,egal Counse4 Legal Caunsel
<br /> NESR.DEPT.UF Y.A�4)1� d
<br /> CHARGE ACCTa 3�1�""f�J
<br /> G�%�'d NOISIhIQ �'�'� 6Jd�;�:c� 65. 80 �3c]
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