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02/21/2002 15:51 FAX 14024714429 NEBRASKA UCC 20020`140 STATE TAX LIEN* NEBRASKA DEPARTMENT OF LABOR X ORIGINAL Z 002/002 ML { ■C of st.in - VAC sTL I 9902195923 -2 Pga: 1 KOSMICKI RANDALL P. Filed: 02120/2002 03:25 PM NDOL Office ofLegal Counsel P.O. Box 94600 Lincoln, NE 68509 -4600 Telephone - (402) 471 -9912 FAX - (4021471.9917 Employer Name: Randall P. Kosmicki d/b /a Randys Sprinkler Service ....... ..... ............................. ................................. ........,. ...................... ................................................ ........................................................................................................................ Address: 4223 Manchester Road Grand Island NE 68803 NDOL Serial No.: LAB -0024 -2002 ................................................................................ ............................... NDOL Employer Acct. No.: 0024891003 Federal ID No. / SSA No.: 47- 0657558 To be tiled with the Register of Deeds in the following Counties: ..................... .......................... : ................................................................. ............................... Hall This State Tax Lien is issued for unpaid combined taxes (Neb. Rev. Stat. §48 -657) or payments is lieu of contributions (Neb. Rev. Stat. §48- 660.01) pursuant to the Uniform State Tax Lien Registration & Enforcement Act (Neb. Rev. Star. §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. 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 thle employer has failed to pay the amount due after demand. Date: February 20, 2002 RETURN FILED COPIES TO: Nebr. Dept. of Labor- LEGAL P.O. Box 94600 Lincoln, NE 68509 -4600 FERNANDO LECUONA,111 of i H. AL-H IN -or- THOMAS A. UKIiNSKI Legal Counsel Legal Counsel NEBR. DEPT. OF LABOR CHARGE ACCT. #14765 ` Combined Tax or �_ Qtr. / Yr. Date Assessed '; Payment In Lieu Of Contributions Due Penalty Interest Subtotal 3/1999 January 9, 2002 $ 810.69 $ 0.00 S 320.14 $ 1 130.83 4/1999 i ......................................,... ............................... ... ..... ............................... .............. January 9, 2002 1 S 105.68 ;...._.............................:......................................... i $ 25.00 $ 36.94 i $ ............'.................. 167.62 ..................................................................... 1/2000 ......:•....................... .....i......................... ........................... ............................... January 9, 2002 $ 0.00.......$..... ............................................ 00 i....................................... .......................... 2/2000 i...................................... ;................................................--...-- January 9, 2002 S 1,263.01 $ .....25. ........................0.0...... 25.00 $ 328.14 a ..6.........._.......25:00..... t $ 1,616.15 , ........................ 312000 .....----................................................................................. ..............................i January 9, 2002 $ 735.75 $ 25.00 S 157.79 •. $ 918 ....... ............................... �............................ ................. -54 4/2000 January 9, 2002 ' S 85.36 $ 25.00 $ 14.43 $ .................... 124.79 ........... .......................... I /2001 ; ......................................; ............................... — .......... .... January ; ... ... ........................... .................................. .......... 9, 2002 $ 19.80 $ 25.00 .4 $ 47.28 ..................................... 2/2001 a...-. ............................... .............. ................ —. .................................. ..............................-.... January 9, 2002 S 825.71 $ ....... ...... ;. ............................... 25.00 $ 65.95 ...... $ ............................... 916.66 ........................ ............. 3/2001 ............................................................................................................................................................ Janua 9 2002 ` $ 778.60 ry $ ....:..,....................... 25.00 $ •f 26.87 ...$ ................830.47.... ..................................... j.......... I........................... i.... ............. ............................... ..... ............................... ..............................' .......... ...................... f i $ 0.00 TOTAL Combined Tax or Payment in Lieu of Contributions Due (under this lien only):. $ 5,777.34 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 thle employer has failed to pay the amount due after demand. Date: February 20, 2002 RETURN FILED COPIES TO: Nebr. Dept. of Labor- LEGAL P.O. Box 94600 Lincoln, NE 68509 -4600 FERNANDO LECUONA,111 of i H. AL-H IN -or- THOMAS A. UKIiNSKI Legal Counsel Legal Counsel NEBR. DEPT. OF LABOR CHARGE ACCT. #14765