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<br />NEBRASKA Dee <br /> <br />19] 005/007 <br /> <br />03/15/2006 15:22 FAX 14024714429 <br /> <br />200602308 <br /> <br />IIlnl'[I~ ;1 <br /> <br />9916443162-6 Pill' 1 <br />CHAGNON TIM <br />FLled, 03/14/2006 10:20 AK <br /> <br />~ <br /> <br />STATE TAX LIEN. NEBRASKA DEPARTMENT OF LABOR <br /> <br />NDOL Office of Legal Counsel <br />P.O. Box 94600 <br />Lincoln, NE 68S09~4600 <br />Telephone - (402) 471-9912 <br />FAX - (402) 471.9917 <br /> <br />1 ORIGJNAL <br /> <br />Employer Name: Tim Chagnon & Chris Tanner iid/b/a T & C Painting <br />-------_._--~-_._"--_...__.__..._,,._-_...__._._--_....---.-.-----..--..-.--..--.-.-..-....--.------.---...-----..-.-------..-----.-.--.----.-.---.....-----.----- <br />Address: 2315 West 11th Street Grand Island NE 68803 <br />NDOL Serial No.: I LAB-0070-2006 To be filed with the Register of Deeds in the foUowing Counties: <br /> <br />~~~-== <br /> <br /> <br />This State Tax Lien is issued for unpaid combined taxes (Neb. Rev. Stat. ~48-657) or payments in lieu of contributions (Neb. Rev. Stat. ~48.660.01) pursWlllt <br />to the Uniform State Tax Lien Registration & Enforcement Act (Neb. Rev. Stat. ~77-3901, et seq.). Notice is given thBt 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 a lien for any and all personal property and real property in the county/coWlties named, belonging to the employer, <br />whether now owned or hereafter acquired. <br /> <br />! Interest <br />\ Combined Tax Or Payment In Lieu <br />'. Date Assessed Of Contributions Due Penalty Tbrough <br />3/8/2006 <br />I <br />1/2003 I 2/21/2006 $61.08 $25.00 $31.41 I $117.49 <br />---._.2/2()03--.....--r-..-"212i/i0Q6--'..-1 ......--...--.-.......-'...'-........--......"--.---...-...-.---c-S;56.95-.T----~--$2"5.00.1 ------.-S.26-:-i.o-r-..-.--.$..loii:'65"... <br /> <br />~~~~r~~ <br /> <br /> <br /> <br /> <br />1 . . I ,$ 0.00 <br />=+-~oiO:= <br />-----t---+----+-----~T.~ <br /> <br />TOTAL Combined Tax or Payment in Lieu of Contributions Due (under this lien only): .. $ 299.14 <br /> <br />Subtotal <br /> <br />'Qtr./Yr. <br /> <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 ofthe amollnt due, and tbe employer has failed to pay tbe amount due after demand. <br />FERNANDO LECUON <br /> <br />Date; March 14,2006 <br /> <br /> <br /> <br />ency Legal Counsel <br />S A. UKINSKI, Legal Counsel <br />SSELL BARGER, Legal Counsel <br /> <br />RETURN FILED COPIES TO: ..Nebr. Dept. of Labor ~ LEGAL <br /> <br />P.O. Box 94600 <br />r .inrnln. NJi'. fiIlSOll...,uinn <br /> <br />NEBR. DEPT. OF LABOR <br />CHARGE ACCT. #1476~ <br />eL <br />