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08/31/2005 09:02 FAX 14024714429 NEBRASKA UCC 0 002 /002 <br />• <br />200508574 <br />Ilia ire of Sibiu - UC6 i7L <br />99®5410242 -'3 Pas; t <br />A 6 N INC. <br />Filed: 0Be30/2005 04:22 PM <br />STATE TAX LIEN • NEBRASKA DEPARTMENT OF LABOR NDOL Office of Legal Counsel <br />P.O. Box 94600 <br />X ORIGINAL Lincoln, NE 685094600 <br />Telephone - (402) 471 -9912 <br />FAX - (402) 471 -9917 <br />Employer Name: A & N Inc_ <br />Address: 228 Cherokee Avenue Grand Island NE 68803 <br />NDOL Serial No.: I LAB - 0135 -2005 To be filed with the Register of Deeds in the following Counties: - <br />NDOL Employer Acct. Ka.- 0256652007 -� - Hall - ) <br />_ _ <br />Federal ID No. / SSA __. No.: 147-0791041 <br />This State Tax Lien is issued for unpaid combined taxes (Neb. Rev. Stat_ §48 -657) or payments in lieu of contributions (Neb. Rev. Seat. §48- 660.01) pursuant <br />to the Uniform State Tax Lien Registration & Enforcement Act (Neb. Rev. Stat. §77 -3901, et seq). 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 demand. These combined taxes or <br />payments in lieu of contributions constitute alien for any and all personal property and real properly in the county /counties named, belonging to the employer, <br />whether now owned or hereafter acquired. <br />Qtr. / Yr. <br />Date Assessed <br />Combined Tax Or Payment In Lieu <br />j Of Contributions Due <br />Penalty <br />......... <br />Interest <br />Through <br />8/24/2005 <br />.. <br />Subtotal <br />4/2002 <br />- 1/2004 <br />8/9/2005 <br />8/9/2005 <br />$18.85 <br />$280.62 <br />$0.00 <br />$0.00 <br />$8.70 <br />$66.54$ <br />$ 27.55 <br />347.16 <br />2/2004 <br />I 8/9/2005 <br />$56.96 <br />$0.00 <br />- -__� $10.92 <br />$ 67.88 <br />- <br />- __ <br />3/2004 - <br />18/9/ 2005 -- -_may_ <br />-- - $82.42 <br />$25.00 <br />�___._._ $ 12.07 <br />- -__ <br />$119.49 <br />4/2004 <br />8/9/2005 <br />$0.00 <br />_ <br />$25.00 <br />_ <br />$0.00 <br />�------ �---- �_�_�.__ <br />$ 25.00 <br />0.00 <br />S 0.00 <br />oo <br />$ o.00 <br />0.00 <br />-.. <br />TOTAL Combined Tax or Payment in Lieu of Contributions Due (under this lien only): <br />$ 587.08 <br />_L- certify.Shatth"Neblra.%4 Deplartntei4 of Labor has_oomplieil with_the EmiploymentSecurity_ Lavv_: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 -M <br />Date: . August 30, 2005 - By: <br />RETURN FILED COPIES TO: Nebr. Dept of Labor - LEGAL <br />P.o. Box 94600 <br />Tinm1n.NK 6AriM9- 46(1(1 <br />(H.'AL> -or- THOMAS A. UKINSIa <br />Legal Counsel Legal Counsel <br />NEBR. DEPT, OF LABOR,_: <br />CHARGE ACCT. #14765( <br />rw' <br />