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01/10/2007 17:38 FAX 14024714429 NEBRASKA Dee @002l007 Po ) '. 200700284 9907489298-9 PSIS' 1 KALLOS NIKKIE J . Filed: 01/10/2007 11:43 A~ ~rATE TAX LIEN. NEBRASKA DEPARTMENT OF LABOR I ORIGINAL NDOL Office of Legal Counsel P.O. Box 94600 IJncobl,~'68509-4600 Telephone. (402) 471-9912 FAX - (402) 471-9917 Employer Name: Nikkie J. Kallos tldJb/a Kallo!i Enterprises Address: 1704 E. 7th Street Grand Island NE 68801 NDOL Serial No.: ! LAB-00I0-2007 I _ NDOL Employer. Acct. No.: 0211888008 . -Federal in No. / SSA No:: 47-0395808 --- ---.-\ i This State Tax Lien is issued for unpaid combined taxes (Neb. Rev. Stdt. ~48-657) or payments in lieu of contnoutions (Neb. Rev. Stat. ~48-660.01) pursuant to the Uniform State Tax Lien Registration & Enforcement Act (Neb. Rev. Stat. ~ 77-390 I, et seq.). Notice is given that combined taxeS or payments in lieu of contributions, intCrest (computed at 1.5% per month), and penaltieS are due from this employer.and remain unpaid after demand. These combined taxes or payments jn:.1ieu of contributions constitute a lien for any and all persomi.l property and real property in the county/counties named, belonging to the employer, whdher now owned or hereafter acquired. Hall Combined Tax Or Payment In Lieu " Interest Qtr. / Yr. Date Assessed Penalty Through Subtotal , Of Contributions Due 11/10/2006 . 1/2002 10/26/2006 . $141.34 .$0.00 $115* $ 256.66 1 0/26/2006-1~- . - --........-..,...,..,---- 2/2002 $80.27. $0.00 $61.85 $ 142.12 -.- - "~ f---- ." .1/2003 10/26/2006 $160.00 $25.00 $101.76 $ 286.76 2/2003 , 10/26/2006j $190.00 $25.00 $112.22 $ 327.22 10/26/2006--r- , --. .-- 3/2003 $0.00 $25.00 $0.00 $ 25.00 -~ . -- ................_._,.~ : 4/2003 10/26/2006 $0.00 $25.00 $0.00 $ 25.00 4/2004 10/26/2006 - -- ---- ..- -----~---_. $350.00 $25.00 $111.81 $ 486.81 --- --~ ......~I..- I $ 0.00 -- - ~_._--:... ~_. : $ 0.00 I -~ -- -'----- ---- $ 0.00 ._~~ --. .. $ 0.00 .......-_.......... - -- --."- I $ 0.00 TOTAL Combined Tal or Payment in Lieu of Contributions Due (under tbis lien only): $1,549.57 . . I certify that the Nebraska Department of Labor has complied with the Employment Security Law of the State of Nebraska in the det~rmination of ~e amount due, and the employer has failed to pay the amount due after demand. FERNANDO LECUONA m Co JO , Agency Legal Counsel T~ A. UKiNSKI, Legal Counsel W US SELL BARGER, Legal Counsel Date: . January 10, 2007 By: RETURN Fn.ED COPIES TO: Nebr. Dept. of Labor - LEGAL P.o. Bu 94600 Lincoln, NE 68509.4600 'NEB&. DEPT. OF LABOR CHARGE ACCT. #1476@