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<br />04/04/2008 FRI 14:09 FAX 402 471 4429 UCC SECRETARY OF STATE 444 Hall <br /> <br />121004/005 <br /> <br />\)00 <br /> <br />200802873 <br /> <br /> <br />9908554794-3 P"s, 1 <br />THIEL SHARON <br />Filed: 04'04/200801:49 PK <br /> <br />STATE TAX LIEN. 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 />~ ORIGINAL <br /> <br />Employer or <br /> <br />Liable Person: Sharon & Jerry Thiel & Ron Spence fJd/b/a Top Dog <br /> <br />Address: 645 S. Locust Grand Island NE 68801 <br /> <br />NDOL Serial No.: I LAB-0057-Z008 To be filed with the Relrister of Deeds in the followinz Counties: <br /> <br />NDOL Acct. No.: 10321595006 Hall I I <br /> <br />Federal ID No.1 SSANo.: I 71-1031245 I I <br /> <br />This Stale Tax Lien is issued for unpaid combined taxes (Neb. Rev, Stat. ~~48-657 and 48-664)or payments in lieu of contributions (Neb. Rev. Stat. ~48-660.0 1) pursuant to the <br />Unifonn State Tax Lien Registration & Enforcement Act (Neb, Rev. Stat. ~77.390 I, et.l'eq.). Notice is given 1hat combined taxes or payments in lieu of contributions, interest <br />(computed at 1.5% 1'<< month), and penalties are due &om tbis employer or person and remain unpaid after demand. These combined taxes or payments in lieu of contributions <br />constitute a lien for any and all personal property and real property in the county/counties named, belonging to the employer or person, whether now owned or hereafter acqUired. <br /> <br /> Combined Tax Or Payment In Lieu Interest ! <br />Qtr. 1 Yr. Date Assessed Penalty Thl-ough Subtotal <br /> Of Contributions Dne 3/22/2008 I <br />4/2007 3/7/2008 $159.06 $0.00 $4.00 $ 163.06 <br /> - <br /> $ 0.00 <br /> , -- . '- <br /> J $ 0.00 <br />-- <br /> I $ 0.00 <br /> I ~ <br /> . $ 0.00 <br /> - <br /> t--- $ 0.00 <br /> $ 0.00 <br />-I $ 0,00 <br />1- $ 0.00 <br /> - <br /> $ 0.00 <br /> I $ 0.00 <br />I <br /> -- <br /> $ 0.00 <br />TOTAL Combined Tax or Payment In Lieu of Contributions Due (under,this lien only): $ 163.06 <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 or person has failed to pay the amount due after demand. <br />FERNANDO LECU <br />mmissio 0 ab <br /> <br /> <br />Date: April 4, 2008 <br /> <br />T:\DOCUMENTS\FORMS\Liens\Original.doc <br /> <br />RETURN FILED COPIES TO: . Nebr. Dept. of Labor . LEGAL <br />P.O. Bolt 94600 <br />Linl.'oln, NE 68509-4600 . <br /> <br />NEBR. DEPT. OF LABOR <br />CHARGE ACCf. #147~ <br />