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<br />11/16/2006 16:38 FAX 14024714429 <br /> <br />NEBRASKA Dee <br /> <br />~ 0021003 <br /> <br />Jro <br /> <br />IIJIIII'I <br /> <br /> <br />~~I~ ~~~/~ 10: 14 RM / <br /> <br />200610267 <br /> <br />STATE TAX LIEN. NEBRASKA DEPARTMENT OF LABOR <br />J ORIGINAL <br /> <br />.NDOL Office of LeglJi Connsel <br />. P.O. Box 94600 <br />Lincoln, NE 68509-4600 <br />Telephone - (402) 471-9912 <br />FAX - (402)-471-9917 . <br /> <br />Employer Name: James A. Matson & Deb Matson d/bla Jade Transmissions <br />..........~.------------------~...... --..... <br />Address: 3090 W. 2nd St. Grand Island NE 68803 <br /> <br />NDOL Serial No.: 'LAB-0238-2006 <br /> <br />-----~ --- -------. <br />NDOL Employer Acet. No.: 0303226001 <br />. . <br />Federal ID No.1 SSA No.: 81-0640267 <br /> <br />I <br />I <br /> <br />Hall <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) pursuant <br />to the Unifonn Sta,te Tax Lien Registration & Enforcement Act (Neb. Rev. Stat. ~ 77-3901; et seq,). Notice is given that combined taxes or payments in lieu of <br />~ntributions, interest (computed at 1.5% per month), llI\d penalties are due from this employer and remain unpaid after demanp. 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 /> <br /> I Combined Tax Or Payment In Lieu ! Interest <br />Qtr. 1 Yr. ! Date Assessed I Of Contri~utions Due Penalty Through Subtotal <br /> 11/11/2006 <br />. 1/2006 10/27/20~W_." $95.00 $0.00 $9.13 $ 104.13 <br /> - -~-~~- <br />2/2006 10/27/2006 I _ $1,206.43 $25,00 $61.26 $1,292.69 <br />~--,--- <br />3/2006 10/27/2006 t--- $580.35 $0.00 $3.15 $ 583.50 <br />~---'-I $ 0.00 <br /> .-. I - <br />-----'---- $ 0,00 <br />-=1 - ..-.~..~- <br />.. ~__$ 0.00",_ <br /> I . $ 0,00 <br /> -- I , - - --t <br /> $ 0.00 . <br /> - ~~.- <br /> I $ 0,00 <br /> I - - <br /> -J- $ 0.00 <br /> - <br /> $ 0.00 <br />-- ~ <br /> I $ 0,00 <br />TOTAL Combined Tax or Payment in Lieu of Contributions Due (under this Den only): $1,980.32 <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 of the amount due, and the employer has failed to pay the amount due after demand. <br />FERNANDO LECUONA. ill <br />. ione f Labor __-. ) <br />,/ <br /> <br />Date: November 16, 2006 <br /> <br />By: <br /> <br /> <br />, Agency Legal COlWSel <br />A. UKINSKI, Legal Counsel <br />_ SSELL BARGER, Legal Counsel <br /> <br />RETURN FILED COPIES TO: Nebr. Dept. of Labor - LEGAL <br />P.O. Box 94600 <br />Lincoln, NE 685()9..4600 <br /> <br />NEBR. DEPT. OF LABOR . <br />CHARGE ACCT. #147(7D <br /> <br />-'-- <br />