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07/12/2005 16:50 FAX 14024714429 NEBRASKA UCC 11005 /006 NE Sao of State - UCC STL l! A00506376 93905402979 P9s: 1 o H s BUI�DERS INC. Filed; 07 12/2006 08:41 PM ........... NDOL Office of Legal Counsel STATE TAX LIEN • NEBRASKA DEPARTMENT OF LABOR P.O. Bog 94600 Lincoln, NE 68509 -4600 X ORIGINAL Telephone - (402) 471 -9912 FAX - (402) 471 -9917 Employer Name: D H S Builders Inc. _— Address: _ 819 No. Diers Avenue 41 Grand Island NE 68803 NDOL Serial No.• I LAB - 01052005 To be filed with the Register of Deeds in the following Counties: NDOL Employer Acct. No.: 0292764005 Hall Federal ID Na. /SSA No.: j 47- 0845272 This State Tax Lien is issued for unpaid combined taxes (Neb. Rev. Star. §48 -657) or payments in lieu of contributions (Neb. Rev. Stat. §48- 660.01) pursuant to the Uniform State TaxLien Registration & EnforcementAct (Neb. Rev. Stat. §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. Thesmbine es 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. ied Tag Or Payment In Lieu Jf Contributions Due $247.58 $1,962.04 $247.70 $102.06 TOTAL Combined Tax or Payment in Lieu of Contributions Due (under this lien only): Interest Penalty Through 6/15/2005 $0.00 $83.61 -� $0,00 -� $308.56 4 Combio Qtr,/ yr. Date Assessed 2/2003 5/31/2005 2/2004 5/31/2005 _ $27. 72 _ $0.00 5/31/2005 ied Tag Or Payment In Lieu Jf Contributions Due $247.58 $1,962.04 $247.70 $102.06 TOTAL Combined Tax or Payment in Lieu of Contributions Due (under this lien only): Interest Penalty Through 6/15/2005 $0.00 $83.61 -� $0,00 -� $308.56 4 Subtotal _$_331.19 $2,270.60 $ 275.42 $ 108.85 $_ 0._00 `$ 0.00 $ 0.00 $ 0.00 $ - 0.00 $ 0.00 $ 0.00 $ 0.00 $2,986.06 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 the employer has failed to pay the amount due miter demand. FERNANDO LECUONA, M Commissioner of Labor Date: July 12, 2005 By- JOHN H. ALB -or- THOMAS A. UIONNSKC Agency Legal Counsel Legal Counsel NEBR. DEPT. OF LABOR [,ETURN FILED COPIES TO: Nebr. Dept. of Labor -LEGAL CHARGE ACCT. #14765 P.O. Box 94600 I I I jarnln. NF 6R5%00 -46110 $0.00 $27. 72 _ $0.00 Subtotal _$_331.19 $2,270.60 $ 275.42 $ 108.85 $_ 0._00 `$ 0.00 $ 0.00 $ 0.00 $ - 0.00 $ 0.00 $ 0.00 $ 0.00 $2,986.06 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 the employer has failed to pay the amount due miter demand. FERNANDO LECUONA, M Commissioner of Labor Date: July 12, 2005 By- JOHN H. ALB -or- THOMAS A. UIONNSKC Agency Legal Counsel Legal Counsel NEBR. DEPT. OF LABOR [,ETURN FILED COPIES TO: Nebr. Dept. of Labor -LEGAL CHARGE ACCT. #14765 P.O. Box 94600 I I I jarnln. NF 6R5%00 -46110