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05/13/2003 15:18 FAX 14024714429 NEBRASKA UCC Z 002/002 <br />200306012 <br />ME asr of S tats, -Mr. ITL <br />990327M252-7 <br />T W CONSTRUCTION <br />Filed: 06113/2003 02;42 PM <br />STATE TAX LIEN e NEBRASKA DEPARTNIENT OF LABOR NDOL Office of Legal Counsel <br />P.O. Box 94600 <br />X 01HGLNAL Lincoln, NE 68509-4600 <br />Telephone - (402) 471-9912 <br />FAX - (402) 471-9917 <br />Employer Name: Tim D. Garrison Pd/b/a T W Construction <br />...... <br />Address: 4339 West Stolley Park Road Grand Island NE 68801 . ...... ..... <br />NDOL Serial No.: LAD-0129-2003 <br />To be filed with the Register of Deeds In the following Counties: <br />N OL Employer Acet. No.: 0257455002 Hall Logan <br />Federal ED No. / SSA No.: 47-0790606 <br />This State Tax Lien is issued for unpaid combined taxes 7Nb. Rev. Stt. W-657)or payments n lieu of contributions (,Nleb. Rev. Star W- 660.01) pursuant <br />to the Uniform State Tax Lien Registration& Enforcement Act (Neb. Rev. Star §77-3901,erseq.). Notice is given that combined taxes orpayments in!jeu of <br />contributions, interest (computed at 1.5% per month), and penalties are due from this employer and remain unpaid after demand. These combined taxes or <br />payments in lieu of contributions Constitute a lien for any and all personal property and real property in the oounty/counti4-- named, belonging to the employer, <br />whether now owned or hereafter acquired. <br />1 <br />Combined Tax Or Payment In Lieu 1 1 Interest <br />Qtr. Yr. Date Assessed Penalty 1 Through Subtotal <br />Of Contributions Due <br />0510812003 <br />3/2001 April 23, 2003 $524.00 $25.00 1 $143.12 <br />692.12 <br />412001 April 23, 2003 <br />.24 $0.00 $51.99 <br />..... .. --------- . . ....... S280.23 <br />2/2002 4ri123,2003 $0.00 $25.00 1 $o-go <br />$ 25.00 <br />. .. . . ..... ..... <br />$ 0.00 <br />0.0 <br />..... ............. ----------- 0 <br />$ 0.00 <br />---- -- ------------------ <br />0.00 <br />0.00 <br />------------- ------ $ 0.00 <br />$ o.co <br />TOTAL- Combined Tax or Payment in Lieu of Contributions Due (under this lien only): <br />$997.35 <br />I certify that the Nebraska Departneut 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 />FERNANDO LECUONA—M <br />Date: May 13, 2003 By: <br />RETURN FILED COPIES TO: Nebr. Dept. of Labor - LEGAL <br />P.O. Box 94600 <br />Lincoln, NE 69509-4600 <br />J H. ALBIN -or- THOMAS A. UKINSKI <br />Legal Counsel Legal Counsel <br />k <br />NEBR. DEPT. OF LABOR <br />CHARGE ACCT. #14765 <br />