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3012512002 12:39 FAX 14024714429 <br />. N <br />NEBRASKA UCC <br />200211688 <br />Ia 003 i 004 <br />F11.- 10121 1.101; <br />12302 11:32 AR <br />STATE TAX LIEN • NEBRASVADEPARTNIM OF LABOR NDOL Office ofLegal Counsel <br />P.O. Box 94600 <br />X DRIGwAL Lincoln, NE 68509-0600 <br />Telephone- (402)471 -9912 <br />FAX - (402) 471 -9917 <br />Employer Name: Roger Thornton d/b/e Thomann Tacking <br />............ _._..._.:____..._ ..................._..............................._......._........................... ...................:..._.._.... _..._....__......._...._..........._...,........_._...._......_..._ <br />Address: 1303 West 19 Street Grand lsland NE 68801 <br />..............._............._. <br />NDO1, Serial No.: LAB -0275 -2002 <br />... .. ........... ._. ............................... <br />.....NDOL <br />To be filed with the Regime of Deeds in the following Comrades: <br />..... _..,. ... _. <br />F.mployor Acer Nor....... 02917490........._ <br />04 <br />Hall <br />Federal l[ No. / SSA No.: 47 -0809509 <br />�in <br />This State Tax Live is iamed £or unpaid combined fazes (Neb. Rev. Scat §t8 -657) m paymemb ben of coaaslmtiwa (Nab Rev. Ssa[. §48- 660.01) <br />piaavact to the Utifores State Tax Lien Rmimztim & Eofoo malt Act (Neb. Rev. Smr. 977 -3901, et seg.). Nodm is given then combined tars or <br />patmcm a in lieu ofcontdbudom, interest (computed at 1.5 %per mamrJ, mdpmaltis are "a from this employeraod wanamunpaid after demand. These <br />combined Wes or payments in lift ofeontributions constitute a lieu foraeyead all penoml propety and mal property in the couoty/couaties named, ie- <br />longiog to the employer, whether vow m mid or bes8er evinced. <br />Combined Tax or <br />Interest <br />Qtr.I Yr. Data Asiemed Payment In Lieu Of Contributions Penalty <br />through <br />Submtal <br />Dane <br />10/DV2o92 <br />1/2300 October 1, 2000 $ 420.00 ` $ 25.00 ! $ <br />183.04 $ <br />628.04 <br />....... .. ......._. ._. ... .. ......... ... _. i.. <br />._.__.,. 2,'200,._..._._.._Octoba 1, 2000 j $ $ 25.0 S <br />..., .._ ___ <br />163.99 j $60899 <br />...........420:0.... .............. <br />Y2000 October 1 2000 $ 420 OD $ 25.0 S <br />._.... <br />144.94 $ <br />._... _.... <br />589,94 <br />._. ..._... ..... .. ..._ ._.... ....... ..., ....... ,....... .,. F. ...... ... .... ... . .... <br />4!2000 ! October 1 2000 $ $ 25 00 5 <br />... <br />125 89 $ <br />.... ...... <br />570.89 <br />_./2 ... .... ...t... . _ .420.00 <br />..... ...._,.. __..._._ :_..,_ .. _ ......... <br />1/2001 October 1, 2000 $ 420.0 $ 25.00 $ <br />..... s <br />107.46 <br />_... .. ...... <br />552.46 <br />... .. .... ..................... .. a._.... <br />> /200I Ocbberl 2000 $ ' $ 2500 $ <br />� <br />. <br />8841 1 $ <br />_ <br />533AI <br />_. _. .. .... ... . .....420:00 <br />._....... ... ......... .. .... _..._... <br />_.,.,,.._ 3/2001 Octobe 1, 2000 i $ 420.0 $ 25.00 $ <br />............ _ <br />69.37 $ <br />.. ..._._. <br />51437 <br />............ ... <br />4/20 07 October! 2000 i $ 42000 ........... <br />$ 2500 $ <br />5032 S <br />49532 <br />12. October 1, 2000 $ i $ 2500 $ <br />31.89 $ <br />476' <br />..,.,42000 <br />2(2002 October 1, 200: $ 420.00 $ 25.0 $ <br />��� ���12.84 i $ <br />457.84 <br />TOTAL Combined Tar or Payment In Lieu of Contr(butions Due (ender this lien only): <br />$ <br />5,428.15 <br />I certify that the Nebraska Department of Labor has compiled 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 />FRRNAN-DO LECUONA, DL <br />Commissioner of labor <br />Data: October 25, 2002 By: <br />SO -ory THOMAS A. LQONSRI <br />Aga ey gal Coouaa .Legal Coueael <br />RETURN FILED COPIES TO: Nebr. Dept. of Labor - LEGAL <br />P.O. Bm 9a60a <br />Llams, NT 611509 -0600 <br />NEBR. DEPT. OF LABOR <br />CHARGE ACCT. #1.4765 <br />