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05/24/2007 THU 16:38 FAX 402 471 4429 UCC SECRETARY OF STATE ~~~ Hall ~002/002 4Dq, 200704269 IIITlllr'l~ m 9907511131-6 Pss: 1 GC8 RESTRURRNT GROUP LLC FLied: OS/24/2007 03:24 PM STATE TAX LIEN 0 NEBRASKA DEPARTMENT OF LABOR NDOL Office of Legal Counsel P.O. Box 94600 Lincoln, NE 685094600 Telephone - (402) 471-9912 FAX - (402) 471-9917 3 ORIGINAL Employer Name: GCB Restaurant Group LLC, fdba Garden Cafe & Bakery ~~-_..._---~~~~_.._~_.~-~-~~---~~~~._-,-...............~~~~~-~._._- Address: 1811 Hillcrest Dr., Bellevue, NE. 68005 NDOL Serial No.: LAB-0147-2007 ------------.---.-. NDOL Employer Acct. No.: 0294259007 Federal ID No.1 SSA No~-rsO-::Oo02665 F To be filed with the Register of Deeds in the following Counties: Sarpy -/IWi----------r -- I '_. +___.__.."~___ I I This State Tax Lien is issued for unpaid combined taxes (Neb. Rev. Stal. ~48-651) or payments in lieu of contributions (Neb. Rev. Stal. ~48-660.0 I) pursuant to the Unifonn State Tax Lien Registration & Enforcement Act (Neb. Rev. Stat. ~77-390 I, el 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 constitute a lien for any and all personal property and real property in the county/counties named, belonging to the employer, whether now owned or hereafter acquired. Qtr. / Yr. i i Date Assessed I Combined Tax Or Payment In Lieu Of Contributions Due Penalty Subtotal Interest Through 3/21/2007 ~~~~-t-~;::~-==-c-- ~;:~~ t=-$~~::~ I=- ~~ 4/2?~~._1~/612007__._J.__________,____._~~.~9'~J SO.OO ~576.0~L-~~~Q75.96 _ 1/2006 3/6/2007 1. $248.23 I $0.00 $39.7~ 288.00 3/2006 3/6/2~~7 __J=~ _-----~$2~_____ $25.00 - $18.99 I $31719- ---+------=t= ._-~-- . += --1 - -r-..- j 1- ----1--.--- .--. I TOTAL Combined Tax or Payment in Lieu of Contributions Due (under this lien only): ~-~ . - $ 0.00 $ 0.00 .- S 0.00 $ 0.00 $ 0,00 -. $ 0.00 --.----.--.-----!.--. I $ 0.00 $3,767.84 Date: 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, m By, ~fQor~ JOHN H. ALBIN, Agency Legal Counsel THOMAS A. UKINSKI, Legal Counsel W. RUSSELL BARGER, Legal Counsel May 24, 2007 RETURN FILED COPIES TO: Nebr. Dept. of Labor. LEGAL P.o. Box 94600 Lincoln. NE 685094600 NEBR. DEPT. OF LABOR CHARGE ACCT. #14765 \ I