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01/19/2007 17:15 FAX 14024714429 NEBRASKA Dee @003/003 ,l\ '-""0 \)~ 200700501' STATE TAX LIEN. NEBRASKA DEPARTMENT OF LABOR ~ ORIGINJ\L NDOL Office of Legal Counsel P.O. Box 94600 Lincoln, NE 68509-4600 Telephone - (402) 471.9912 FAX- (402) 471-9917 Employer Name: lason Lawhorne & Bryon Runnfeldt fJdlb/a Lawhorne Construction (partnership) -----~-~~~~~~~..... .... Address: 710 Kimball Grand Island NE 68801 NDOL Serial No.: ! LAB-0020-2007 . To be filed with the Register of Deeds in the followiDg Counties: NDO~~~~oyer .Acct. No.: 1;0296~ -==-.. =Hall-==~~l._ ~==- J ~--- Federal In No.1 SSA No,: I 41-2053034 This State Tax Lien is issued for unpaid combined taxes (Neb. Rev. Stat. ~48-657) or paymentg in lieu of contributions (Neb. Rev. Stat. fi48-660.01) pursuant- to the Uniform State Tax Lien Registration & Enforcement Act (Neb. Rev. Stat. fi77-3901, et seq.). Notice is given that combined taxes or payments in lieu of contributions, interest (computed at 1.5% per month), and penalties are due from this employer and remain unpaid after demand. These combined taXes or payments in lieu of contributions consti lute a lien for any and all penonal property and teal property in the county/counties named, belonging to the employer, whether now owned or hereafter acquired. I ! Combined Tax Or Payment In Lieu Qtr. 1 Yr. I Date Assessed Of Contributions Due i __ 4/2~~~.~EE~~'11_-.. ____~8.~~ - ~~~~~~ -+--.~ ~~~~~~.~~-~'I -------~~::~6- -3j2005-'--;liI2212oo6-~1 ------$256.55 .--4t20ciS--~ 11/22/2006 -..-r------------;-.-.. $357.98 .__----{-o- -..-r~:=~---~-_._~--=~-~l- .~ t~--~- I I ----.--f- -.---------. ~ I ..._, -'1---' I Interest Through 12/7/200'6 $19.33 $4.04 $5.97 $50.84 $54.71 Penalty $25.00 $25.00 $25.00 $25.00 $25.00 TOTAL Combined Tax or Payment In Lieu of Contributions Due (under tbis Uen only): Subtotal I $ 102.43 $ 43.04 $ 55.47 $ 332.39 $ 437.69 $ 0.00 $ 0.00 $ 0.00 $' 0.00 $ 0.00 $ '0.00 $ 0.00 S 971.02 I 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 LECUONA, ill ~fLabor BY:~- LAY-- ~ JOHN H. ALBIN, Agency Legal Counsel THOMAS A. UKlNSKI, Legal COl,lD.Sel W. RUSSELL BARGER, Legal Counsel Date: January 19, 2007 RETURN Fll..ED COPIES TO: Nebr. Dept. of abor - LEGAL P.O. BOI[ 94600 NEBR. DEPT. OF LAB~\ CHARGE ACCT. #147\'1r