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<br />01/25/2007 17:35 FAX 14024714429 <br /> <br />NEBRASKA Dee <br /> <br />IaI 0021002 <br /> <br />~ <br /> <br />200700634 <br /> <br />lllllllln"II~11I <br /> <br />99074923SS-6 Pgs: 1 <br />KOSMICKI EUGENE <br />Filed: 01/25/2007 12:00 p~ <br /> <br />E ORIGINAL <br /> <br />STATE TAX LIEN 0 NEBRASKA DEPARTMENT OF LABOR <br /> <br />NDOL Office of Legal Counsel <br />P.O. Box 94600 <br />Lincoln, NE 68509-4600 <br />Telephone - (402) 471-9912 <br />FAX ~ (402) 471-9917 <br /> <br />Employer Name: Eugen.e Kosmicki <br />-- <br />Address: 1307 West Division Street, Grand Island, NE. 68801 <br /> <br />NDOL Serial No.: LAB-0025-2007 To be filed with the Register of Deeds in the following Counties: <br />NDOL Employer Acct. No.: 0302435007 Hall <br /> - - <br />Federal ill No.1 SSA No.: <br /> <br />This State Tax Lien is issued for unpaid combined taxes (Neb. Rw. Stat. ~48-657) orpayments in Heu of Contributions (Neb. Rev. Stat. 948~60.0]) pursuant <br />to the Unifonn State Tax Lien Registration & Enforcement Act (Neb. Rev. Stat. ~ 77-390 I, et seq.). Notice is given that combined taxes Otpayments 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 combiQed 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 /> Combined Tax Or Payment In Lieu I Interest I <br />Qtr:./ Yr. Date Assessed Penalty Through Subtotal <br /> Of Contributions Due 12/19/2006 <br /> 2/2001 12/4/2006 $48.20 I $25.00 $44 .55 $117.75 <br />- ~- <br /> 3/200 I ] 2/4/2006 $88.31 $25.00 $81.63 $ 194.94 <br /> 4/200 I ' 12/4/2006 $119.00 $25.00 $104.60 $ 248.60 <br /> 1/2002 12/4/2006 $112.96 $25.00 $94.34 $ 232.30 <br /> 2/2002 - <br /> 1214/2006 $1l.45 $25.00 . $9.04 $ 45.49 <br /> ~--1-_ $ 0.00 <br />- -- <br /> 1 : 0,00 <br /> ---..- <br /> 0.00 <br /> 0.00 <br /> $ 0.00 <br />- ~ - <br /> $ 0.00 <br /> " .- <br /> S 0.00 <br />TOTAL Combined To:: or Payment in Lieu of Contributions. Due (under this lien only): $ 839.08 <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, m <br />. Commi sione of <br /> <br />Date: January 25, 2007 <br /> <br />By: <br /> <br /> <br />BIN, Agency Legal Counsel <br />A. UKlNSIO, Legal Counsel <br />ELL BARGER, Legal Counsel <br /> <br /> <br /> <br />NEBR. DEPT. OF ~1 <br />CHARGE ACCT. #14765 <br /> <br />RETURN mED COPIES TO: Nebr. Dept. of Labor - LEGAL <br />P.O. Box 94600 <br />Unwin, NE 68509-4600 <br />