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<br />03/12/2008 WED 15:15 <br /> <br />FAX 402 471 4429 UCC SECRETARY OF STATE ~~~ Hall <br /> <br />121002/003 <br /> <br />00 <br /> <br />200802083 . <br /> <br />Imlllllllllrl <br /> <br /> <br />9908551444-9 Pgs: 1 <br />$~rr.~7c0g~n92008 01:26 PM <br /> <br />STATE TAX LIEN. NEBRASKADEPARTMENTOFLABOR <br /> <br />NDOL Office of Legal Counsel <br />P.O. Box 94600 <br />Lincoln, NE 68509-4600 <br />Tdephone - (402) 471-9912 <br />FAX - (402) 471-9917 <br /> <br />~ ORIGINAL <br /> <br />Employer or <br /> <br />Liable Person: DaVid Janovec fJdlb/a Grounds To Go <br /> <br />Address: 644 S. Locust Street Grand IslandNE 68801 <br /> <br />NDOL Serial No.: ! LAB-0047-2008 To be moo with the Reaister of Deeds in the ~ing Counti~-=---_ <br /> <br />-------miOL Acct. No.: I 0289783002 Hall . I ~' <br /> <br />Federal ill No./ SSA No.: I 91~1762829 I I <br /> <br />This State Tax Lien is issued for unpaid combined taxes (Neb. Rev. Stat. 1148-657 and 48-664) or payments in lieu of contributi~ (Neb: Rev. Slat. 148-660.01) pUIliwmt to the <br />Uniform State Tax Lien Registration & Enforcement Act (Neb. Rev. Slol. 177-390 I, elIBq.). Notice is given that combined taxes or payments in lieu of ContribUtillllS, intefest <br />(computed at 1.5% per month), and pemtlties are due fium this employer or pefSOn and remain unpaid after demand. These.combined taxes or payments in lieu of contributions <br />constitute II lien for any and all personal property and real property in the county/counties named, belonging lothe employer or persOll, whether now owned or hereafter acquired.. <br /> <br /> i Combined Tax Or Payment In Lieu Interest I <br />Qtr,/Yr. Date Assessed I Penalty Tbrough I Subtotal <br /> Of Contributions Due 3/8/2008 ! <br />3/2007 2/22/2008 $336,00 $25.00 $21.37 $ 382.37 <br /> --. -- 1---- <br /> $ 0.00 <br />--- . - <br /> $ 0.00 <br /> -----=1= ~~-- <br /> $ 0.00 <br />--------- 1---------,---.- <br /> $ 0.00 <br /> ---------.........~- <br /> · $ 0.00 <br /> - - __ ~ "~$-O~OO <br />~----=r=---.-'-;-- <br /> I $ 0_00 <br /> ,-- J=--~.OO - <br /> $ 0.00 <br /> - --- <br /> $ 0_00 <br /> - ~----.- <br /> $ 0.00 <br />TOTAL Combined Tax or Payment in Lieu of Contributions Due (under this lien only): $ 382.37 <br /> <br />I certify that the Nebraska Department of Labor has complied with tbe Employment Security Law of the State of Nebraska in the <br />determination of tbe amount due, and the employer or person has failed to pay the amo ter demand. <br />FE~ANDO <br /> <br />Date: March 12, 2008 <br /> <br />By: <br /> <br /> <br />gency Legal Counsel <br />o AS SKI, Legal Counsel <br />USSELL BARGER, Legal Counsel <br /> <br />T:\DOCUMENTS\FORMS\Uens\Original.doc <br /> <br />RETURN FIT..ED COPIES TO: . Nebr. Dept. of Labor - LEGAL <br /> <br />P.O. BOll: '4~O <br />Lincoln, NE 68509-4600 <br /> <br />NEBR. DEPT. OF LABOR <br />CHARGE ACCT. #14700 <br />