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<br />03/29/2007 15:06 FAX 14024714429
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<br />NEBRASKA Dee
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<br />Igj 002/002
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<br />200702521
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<br />
<br />IIlE
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<br />Db
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<br />9907502885-2 Pili: 1
<br />KALLOS NIKKIE J.
<br />Fil~: 03/29/2007 09:38 AM
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<br />STATE TAX LIEN. NEBRASKA DEPARTMENT OF LABOR
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<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
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<br />~ AMENDMENT
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<br />Employer~Name: Nikkie J. Kallos fi'dIb/a Razzy's Lounge
<br />._--"--':."~-~~704E:7il'Str;~GrandIsIan(rNE-68801~-'
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<br />NDOL Eniployer Acct. No.': 0211888008
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<br />-~---,._--~----"""""~,~"""-""""-"""",~,-~---------~-"",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,-_.~---~--_,_----_~~--_._---'...~~---,--,.......................~............_-,
<br />Federal ID No. / SSA No.: 47-039,5808 .
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<br />This is an AMENDMENT of BJi existing lien and serves to amend/correct and continue the lien and priority of the Nebraska Department of Labor on the
<br />affected pro~ertY of this employer. This amendment is filed pursuant to Neb. Rev. Stat. ~8-657, Neb. Rev. Stat. ~8-660.0 I, and the Unifonn State Tax Lien
<br />Registration & E!lforcement Act (Neb. Rev. Stat. ~77.3901. et seq.)." Notice is given that combined taxes or payments in lieu of contributions, interest
<br />(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
<br />contributions constitute a lien for any and all personal property and real property in the county/counties named, belonging to the employer, whether llOW owned
<br />or hereafter acquired. This State TaX Lien amends the Nebraska tJepartment of Labor's interest in the affected property of the employer.
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<br />LIEN TO BE AMENDED:
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<br />Hall County Document N. 00700284
<br />~-_..... ._______,...............w..._..
<br />Other Filing Information: amended to change name to Razzy's
<br />Lounge
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<br />. i 1 Combined Tax or j Interest
<br />Qtr. / y~. I ':Date Assessed I Payment In Lieu Of Contributions Due' i>>enalty through Subtotal
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<br />~ ~:~t- t-i~=~~+-==== ~ :~~ ~: ~~! ~~i
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<br />3~ .~~- -~T.54957
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<br />, TOtAL Combined Tn or Payment in Lieu of Contributions Due (under thilllien only):
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<br />NDOL Serial No. LAB-OOIQ-2007
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<br />State Tax L~en Document ~99b1489298))
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<br />Date:
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<br />I certify that the Nebraska Department of Labor has complied with the Employment Security Law of the St~te 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 />Commissioner of Labor
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<br />By: ~. G ( -----4
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<br />JOHN H. ALBIN, Agency Legal Counsel
<br />mOMAS A. UKlNSKI, Legal Counsel
<br />W. RUSSELL BARGER, Legal Counsel
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<br />March 28, 2007
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<br />U:\Word\FORMS\Liens\Amendmentdoc
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<br />RETURN FILED COPIES TO: Nebr. Dept. of Labor - LEGAL
<br />P,O. Box 94600
<br />Uncaln, NE 68509-4600
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<br />NEBR. DEPT. OF LABOR
<br />CHARGE ACCT. #14765
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