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10/03/2002 15:01 FAX 14024714429 NEBRASKA UCC 2002/002 <br />naaxa7_a <br />200210607 U.; join, IN, A M <br />STATE TAX LIEN* NEBRASKA DEPARTMENT OF LABOR NDOL Offic. ofLegad Counsel <br />P.O. Box 94600 <br />X OWGM� Lincoln, NE 68509-4600 <br />Telephone .(402) 471-9912 <br />EmployerNanne: Tom Meaftbrink f/dbla Elite Business Concepts <br />... ...... .. .... ­1 ............................. . I ..................... - .... . ........ ............. ........... . ...... .. . .... . ............. ...... . ................ . . ................... I ............... .... ....... ..... .­­ ......... ...... <br />Address: 1324 W N I.= Grand Island NE 68801 <br />........ N . D . 0 .. L S . ex .. W .1. .N.A.: LAB -0250 -2002 !e,.Rgist� of Deeds in the following Counties: <br />.... .. ........ I ....... I .. ...... ........ <br />NDOL Employer Aect.No: 0246616000 Hall <br />I . ......... I I ............... ... . ............ . ...................... . ...... . ........ . ...... . . ...................... .. . .. ... ............. . ................. I ....... . ...... ... ........ <br />Federal 1D No. i SSA No.i 47-0758534 <br />This Spot Tax Lim 1S issued -.'er unpaid combined taxes (Neb. Rev. Star. <br />puscanl no tic Urnifirson S,.w T. Lt. Reli-tration, & Eacf¢eppprpt Act (Neb. Rev. Sort §77-3901, at reg.), Notice is given that combined uxes <br />payments . licofenotnixubrou" lowest (computed at 1.5%permopth� AacdPWAItiCS Maine from this caployerandremaintmpaidafter demand Three <br />combined unoes arsymerns in lien ofeentribudoes; consti a lift for anyand all personal property cadrasl property in the counWonectian nomad, be <br />Combined Tax or <br />Qtr. 1 Yr. I Dam Assessed Payment In Lion Of Contributdow <br />Penalty Interest <br />Subtafid <br />Due <br />1/2000 i Sept 131 2002 :1 $ 415.95 S 2500 177.58 $ 618.53 <br />1- .............. ................ ............. ..... ..... ... . ........ .... <br />2,2000 57.01 $ 23141 <br />Sept. 13, 2002 1�mo i <br />........ . ........... . 4­.­ --- - --- .. ..... ..... ... ... . ........ .... ............... <br />­ . ........ �UT 4 . .. ... <br />3/2000 1 Sept. 13, 2002 S S 5.00 $ 0.00 1 $ 25.00 <br />........... ......... . 11 . . .......... . ..... ......... ..... ... ............ ............. <br />13, 2002 S 0.00 25.00 S 0.00 $ 25.00 <br />... .. ..... " ...... . ....... . ...... . ........ . ... . ........ ............... .. . . ...... . .... ­ ........... ...... I ........ . ................ .... ........ . ..... .............. <br />S.VL 13.2002 346.40 S 25.00 $ S5.56 $ 456.96 <br />....... ... .............. . ... . ................................ ..... ....... . ......... + - <br />2/2001 Sept. 13, 2002 $ 67.87 i $ 25.00 5 13.69 ! $ 106,56 <br />............... ........ . ... . ..... ............ .. ...... . .......... .. ......... .. <br />$ <br />..... ... ...... - - ------- - -- . ...... ....... . ...... --- ------ - . ........... ...... ... .. . .... . .. ......... ..... <br />.............. ............... ............ ...................... ... ........ ............. . ..... ............. . ...... <br />i 0.00 <br />i $ 0.00 <br />........ . . ... .... .................... . .. ........ I...., .. . .................... . . . .. . ........ <br />.......... - .. . ...... . ..... . ...... . ... <br />O'Do <br />TOTAL Combined Tax or Payment In Lieu of Contributions, Due (moler this lien only): <br />$ 1,463.46 <br />1 cerdly that the Nebraska Department of Labor has complied with the Eanihoynanot Security Low of the State of Nebraska in the <br />determination of the aramsuat due, And the employer bas failed to pay the Amount due after demand <br />FERNANDO LEC17ONA. III <br />Data: October 3, 2002 <br />It- <br />Legal Counsel Legal Counsel <br />RETURN FILED COPIESTO: Nebo. Dept. Of Lobar -LEGAL NEBR_ DEPT. OF LAB. <br />OR <br />P.O,Do.94600 CHARGE ACCT. #14765 <br />