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<br />09/11/2007 TUE 15:39 <br /> <br />FAX 402 471 4429 UCC SECRETARY OF STATE ~4~ Hall <br /> <br />1210071007 <br /> <br />~ <br />\) <br /> <br />200707854 <br /> <br />11111"'11' <br /> <br /> <br />9907525129-7 <br />DOMINdlCK09S/C1~1~007 03:08 PM <br />File: <br /> <br />STATE TAX LIEN. NEBRASKADEPARTMENTOFLABOR <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 />1 ORIGINAL <br /> <br />Employer or- <br />Liable Person: Scott & Carla Dominick f/d/b/a Crooners <br />-----.-.-..-.--..---..-.Add~~~-m-W4HistGi:aiidISialliiNE"688o"i4504.-..--..--.--...-"..--..------.-~.-."'-.---..---..-....----...----------- <br />________~!?Qh~!!:!~1 ~~3.. ~:0243-2007 .______.____ To .be file~_~!!.~.!.~e ~~!!"~-'?I~.!.~~~J!l~!.It~~.!!!?.!"i!!lt~~~ties~--- <br /> <br />---.F-ed~r~-i"rt.g~fs~~.~~ ~6tJtt~i---'- : -..~ -lIEl-c-..-.---f---...--.-..---.-----.-.--r---'-----,--..--.--..... <br /> <br />This Slate Tax Lien is issued for unpaid combined taxes (Neb. Rev. Slat. ~~48-6S7 and 48-664) or payments in lieu of conl1ibutions (Neb. Rev. Sial. ~48-660.0 I ) pursuant to the <br />Unifonn State Tax Uen Registration & Enforcement Act (Neb. Rev. Slat. F7-390 I, el seq.). Notice is given that combined taxes 01" paytnenlli in lieu of contributions, intel'eSt <br />(computed at 1.5% per month), and penalties are due from this employer 01" person and remain unpaid after demand. These combined taxes or payments in lieu of conbibulions <br />constitute a lien for any and all personal propelty and real property in the county/counties named, belonging to the employer or person, whether now owned or hereafter acquired. <br /> <br />I Interest <br />Combined Tax Or Payment In Lieu I <br />Qtr. / Yr. Date Assessed OfC'b' D "penalty Through Subtotal <br />ontn utlOns ue I 8/22/2007 <br />- I <br />-~-~~~}~~~------t-~-:;~~~~~~--.."..-.t-....-"m.-.."..--.-..-.----.--.----.-.-..----~----$~~.6:~-i+-~-.,..-"~$~~:"~-~+.....--......-......$~~:6~-' ~--.-.-,-$\~-:~i~. <br />. ~~~~ -=====i~~.~i~ ~ <br /> <br /> <br />--------..---.----.- .-----.----....----- ---.---.-----.-.---'--~ -...-.-.----.-.-----.m..t-."--~-- --~.- ~ ~:~~- <br />===~-=--=~. =~=_-~~_~~~~+'"-~... ~=~=_=_-=-~=__==__=_-=_=~=~===~==~~~.--.~===~=~=== ~.~ $_0.00 <br />$ 0.00 <br />~...._~~~~_...............__ ~_~r_~~.~~.~__ ...__.__.................._.........~____. ~~__~.__~_ ~~~~~_ <br />I $ 0.00 <br />TOTAL Combined Tax or Payment in Lieu of Contributions Due (under this lien only): $ 936.90 <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 tile employer or person has failed to pay the amount due after demand. <br />FERNANDO LECUONA, III . . <br />Co~ofLabor- <br /> <br />D.te: Sep_be< 11,2007 By'. ~ ~ t1 <br />HN H. ALBIN, Agency Legal Counsel <br />T:\OOCUMENTS\FORMS\Liens\Original.doc THOMAS A. UKINSKI, Legal Counsel <br />W. RUSSELL BARGER, Legal Counsel <br /> <br />RETURN FILED COPIES TO: Nebr. Dept. of Labor - LEGAL <br /> <br />P.O. Box 94600 <br />Lintoln, NE 685094600 <br /> <br />NEBR. DEPT. OF LABOR <br />CHARGE ACCT. #147~ <br />