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08/12/2005 16:44 FAX 14024714429 NEBRASKA UCC Q002/002 <br />200507892 <br />wr s.e of lists - UM sr� <br />III 11111111 gill <br />9905467675 --7 Pas: i <br />TOMPKIN DANA <br />F116d: 00/12/2005 11:18 AM <br />NDOL Office of Legal Counsel <br />STATE TAX LIEN a NEBRASKA DEPARTMENT OF LABOR P.O. Bog 94600 <br />X ORIGINAL Lincoln, NE 68509 -4600 <br />Telephone - (402) 471 -9912 <br />FAX - (402) 471 -9917 <br />Employer Name: Dana Tompkiu d/b /a Eclipse Drafting & Consttuction <br />—�— Address: - 11750 South 190' Road Wood River NE 68883 <br />NDOL Serial No.: LAB -0110 -2005 To be filed with the Register of Deeds in the following Counties: - <br />NDOL Employer Acct. Na.: X0295120001 — Hall __ -- Buffalo <br />Federal ID No. / SSA No.: 81- 0572697 <br />This State Tax Lien is issued for unpaid combined taxes (Neb. Rev. Stat- §48 -657) or payments in lieu of contributions (Neb. Rev. axe or payments pursuant <br />to the Uniform State Tax Lien Registration & Enforcement Act (Neb. Rev, Star. §77 -3 901, et seg.). Notice is given that combined taxes or payments in lieu of <br />contributions, interest (computed at 1.5% per month), and penalties are due from this employer and remain unpaid after deman& These combined taxes or <br />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, <br />whether now owned or hereafter acquired <br />Interest <br />Qtr. / Yr. ! Date Assessed Combined Tax Or Payment In Lien Penalty Through Subtotal <br />Of Contributions Due 7/21/2005 <br />2/2003 7/6/2005 $1.47.77 $25 -00 $52.53 $ 225.30 <br />4/2003 �. 7/6/2005 �_- _ $46.02 T -� $25.00 — $12.18 — $ 83.20 <br />1/2004 - -- 7/6/2005 — $414.47 $25.00 $91.34 $ 530.81 — <br />2/2004 7/6/2005 ... $317.73 —� $25.00 __ _ $55.61 $ 398 -34 <br />3/200.4 7/6/2005 + _.�� —$2.80 $2500 —� $0.36 $ 28,16 <br />�._.._.._. _ _ _ _. 0 $ 0.00 <br />$ 0.00 <br />$ 0.00 <br />$ 0.00 <br />TOTAL Combined Tax or Payment in Lieu of Contributions Due (under this lien only): $1,265.81 <br />I certify that the Nebraska Department of Labor has complied 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 />FERNANDO LECUONA, III <br />miss a La or <br />Date: August 12, 2005 By: <br />-or- THOMAS A. UKINSKI <br />7Vency'Legal Counsel Legal Counsel <br />RETURN FILLED COPIES TO: Nebr. Dept. of Labor - LEGAL NEBR. DEPT. OF LABOR <br />P.O. Sox 94600 CHARGE ACCT. #1476-5 <br />T.inrnln. NF. G9509 -4600 <br />