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01/12/2006 10:23 FAX 140247.14429 NEBRASKA Dee 141 003/003 Ii ~ 200600309 111111""" 9916430813..2 PSlI . RRMIREZ MARIBEL Fil_d, 01/09/2006 10:53 AI'I STATE TAX LIEN. NEBRASKA DEPARTMENT OF LABOR 1 ORIGINAL NDOL Office of Legal Counsel P.O. Box ~4600 Lincoln, NE 68509-4600 Telephone - (402) 471-9912 FAX - (402) 471-9917 Employer Name: Maribel Ramirez fJdIb/a Unique Auto Ddailing ------_._-_.........------~--~---'~._.-._--_._......---...--~--~_--.--..&_-----~.....-----------~~~-~--_..............~._.._,-_.~................~~---_.~-~~--_..............~-~-~--_.~-_.............. - Address: 708 S. Locust Ave. Grand Island NE 68801-6765 NDOL Serial No.: I LAB-0018-2006 To be tiled with the Register of Deeds in the following Counties: .________,___._________________L_.....__._________..___-...-..-' ------.------l.------..-.....--....------ ---- ..---.-..... .....--- NDOL Employer Acct. No.: I 0302792000 Hall --I -. ---- ___.._..___._________._.'.__..._........_!..__..._._____...__..._-..-,....---....-..--.-----.--..----..-..--.-.-..1---...,.---.-..--,----......-..-1------....-....-..--..----..-. Federal ID No.1 SSA No.: i 72-1574398 ! - ! This State Tax Lien is issued for unpaid combined taxes (Neb. Rev. Stat. ~48-657) or payments in lieu of contributions (Neb. &v. Stat. ~48-660.01) pursuant 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 contributions, interest (computed at 1.5% per month), and penalties arc due from this employer and remain unpaid after demand These combined 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 owned or hereafter acquired. I 'I Qt / Y 1 Date Assessed Combined Tax Or Payment In Lieu r. r. Of Contributions Due . I 1/4/2006 1/2004 12120/2005 $70.00 I $25.00 $21.19 $ 116.19 ~~-~~O+-=-$~Ol~ =3n~ ~onOO5 _~~25=F--=-,~.~ -~~o.oo ===+-- ~ - ==F t==H: ====+==--t=======~1 ====f==-~ =-~=-=="-t=~====~-~".--t~~===~.:',~.~~~~~~=.=.===~~===.l=-==~_=~~=~~=..1~==:==~~===~J=--=~===I-~~oo = 1 ' 11 i $ 0.00 TOT ALCombined Tn or Payment in Lieu of Co~tributions Due (under this lien only): I $ 339.04 . ' I certify that the Nebraska Department of Labor has complied with the Employment Security Law of the State of Nebraska in the determination oftbe amount due, and the employer has failed to pay the amount due after demand. FERNANDO LECUONt\, m C mlSSlO r 0 Penalty Interest Througb Subtotal Date: January 9,2006 ,By: -or- THOMAS A. UKINSKI Legal Counsel RETURN FILED COPIES TO: , Nebr. Dept of Labor- LEGAL P.O. Box 94600 l.in~/\In_ NF. (,;11<;09-46110 NEBR. DEPT. OF LABOR CHARGE ACCT. #14765 '\1)