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09/09/2005 10:08 FAX 14024714429 NEBRASKA UCC 200508895 �i'1UATE WAX LIEN • NEBRASKA DEPARTMENT OF LABOR X ORIGINAL Employer Name: Fortec, LLC -- ~� Address: 810 E. 4th Street Grand Island 68801 NDOL Serial No.: I LAB- 0137 -2005 NDOL Employer Acct. No.: x0289742000 Federal lD No. /SSA No.� 47- 0844115 IM 002/002 NE are of aiai• - VC[ STL i i 09054113z7 -g FORTEC, L FLI.d: 09!08 /2008 10:26 AM NDOL Office of Legal Counsel P.O. Box 94600 Lincoln, NE 68509-4600 Telephone - (402) 471 -9912 FAX - (407.1 d71-oui,7 To be filed with the Register ofDeeds in the following Counties: This State Tax Lien is issued for unpaid combined taxes (Neb. Rev. Stat. §48 -457 or a to the Uniform State Tax Lien Registration & Enforcement Act (Neb. Rev. Stat §77 -3901e tseq.)1iNotice is given that combined taxes §or pa�0A1s in lieu of contributions, interest (computed at 1.5 °/u per month), and penalties are due from this employer and remain unpaid after demand. These co bin d taxes 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 awned or hereafter acquired. Qtr. I Yr. I Date Assessed 4/2004 { 8/16/2005 Combined Tax Or Payment Iu Lien Of Contributions Due $481.09 TOTAL Combined Tax or Payment in Lieu of Contributions Due (under this lien only): Interest Penalty Through 8/31/2005 $36.47 $50.28 Subtotal $ 567.84 $ 0.00 $ 0.00 $ 0.00 _ $ 0.00 _ $ 0.00 $ 0.00 _$ 0.00 $ 0.00 $ 0.00_ $ 0.00 - $ 0.00 $ 567.84 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 after demand. FERNANDO LEcmN.jir Date: September 8, 2005 nity -or- THOMAS A. UIG NSKC nc al Counsel Legal Counsel r) RETURN FILED COPIES TO: Nebr. Dept. of Labor- LEGAL NEBR. DEPT. OF LABOR P.Q- Box 94600 CHARGE ACCT. #14765 Tinrnln.NF 68109 -d60n