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Q3%25/2002 17:45 FAX 14024714429 NEBRAS KA GCC T�L 200202461 2002/002 LL)(ORGrTN TAX LIEN • NEBRASKA DEPARTMENT OF LABOR NDOL Office ofLegal Counsel P.O. Box 94600 Lincoln, NE 68309 -4600 Telephone- (402)471 -9912 FAX - 402 471 -9917 Employer Name: Richard Adams cl b/a Complete Detail ...._.....Address:.. .................................... 724 W. Louise Str eet.. ur ........ .................................. _. .......... ... .... ...._.._.......................... ............... _ .................................. ...... ... _........ and lsland NE 68801 Y NDOL Serial No.: LAB -0063 -2002 To be filed with the Register of Deeds in the following Counties: _............................ . ..._. .....................,................._................._............._.............. ....... -..._ ..... ........_._. ...................... ... .................... . .... _ ...... ........... _ ................. _..... ... NDOL Employer Acct No,: 0285859004 Hall ...... _ ... ..._..-- -- - --- ----.._._..._............._ ................. .......... ......... _--.. ............. .... .._ ..... . ........... ... ........._.__.,.............. .... ........... . ............... _:......... ....... ........ ........ ............ . Federal ID Na. / SSA No.: 47- 0833153 This State Tax Lien is issued forunpaid combined taxes (Neb, Rev. Stat. §48 -657) 4 payments in lieu of contributions(Neb. Rev. Stat. §48- 660.01) pursuant to the Uniform State Tax Lien Registration & Enforcement Act (heb. Rev. Stat. §77-3901, etseg.} Notice is given that combined taxes or payments in lieu of contributions, interost (computed at 1.5% per mnnth), and penalties are due from this employer and remain unpaid after demand. These onmbined taxes or payments in lieu or contributions constitute a lien for any and all personal property and real property in the cotmry /counties named, belonging to the employer, whether now owned or hereafter acquired. Combined Tax or I Qtr. / Yr. € Date Assessed ': Payment [a Lieu Of Contributions Due < Penalty Interest Subtotal 3120DO Feb .26, 2002 I S 70.00 1 S 25.00 i$ 16.67 i S 111.67 ..... .. b ........................ _ .... .... ....... ....._. .......... .... ..... .._....... ..i.................................. J ....... ............,............. J ......... .... .... ._......_........._ ... 000 - Feb 26, 2002 1 S 70.00 i S 25.00 I S 13.49 1 $ 108.49 F.....................:_. _ _....... _. _ _...... _......... - . . _. _ ......... ......... _............ _..... _.:..... ..........._................: -. _......................... _ _... . Feb. 26, 2002 i $ 70.00 i S 25.00 $ 105.42 ................ I20D1 ............. ..........._......._........... 10.42 j $ . 25.00 '•, $ 7.25 j $ 102.25 ....... eb ...........................:........:............ .._............................ _............_....................._........_... .............................._ 4 2001 Feb. 26, 2002 $ 70.00. $ .......... s Feb. 26, 2002 $ 70.00 $ _..........._.. I....._..........;. .07 } S 99.07 _._..........1 25.00 I D $ 4 j............ I $ .........0:90 ........ ........ 95.90 ......:.. . ..............:.._....:.{....._ ............. .............,...:........ _.... i ` ....... ....... .......... '..5............. -'0,00 . ............._.............. ..._.......I....._........- - --. - .._............ _....................:...... ..... .......... ........................................_...---...........:...........................,............_....................... ........._........ }..........._ _ ........ ..... ._.:_. ................ ... .......... ;..5........_......_... ..: ...... _ I S 0.00 I S 0.00 TOTAL Combined Tax or Payment In Lieu of Contributions Due (under this Ilan only): ! $ 622.80 1 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. FERNANDO LECUONA, III Date: March 25, 2002 Legal Counsel RETURN FILED COPIES TO: Nebr. Dept, of Labor- LEGAL P.a Box 94600 Lincoln, NE 68509-4600 4 THOMAS A. UKI NSKI Legal Counsel NEBR. DEPT. OF LABOR CHARGE ACCT. #14765