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<br />04/04/2008 FRI 14:09 FAX 402 4714429 UCC SECRETARY OF STATE ~~~ Hall <br /> <br />121005/005 <br /> <br />\)~ <br /> <br />11111'111111"111' <br /> <br /> <br /> <br />9908554795-5 Pas. 1 <br />R~SS'S CAR WASH INC. . <br />FlIed: 04/04/200801:49 PM <br /> <br />200802874 <br /> <br />STATE TAX LIEN. NEBRASKADEPAR1'MENT OF LABOR <br /> <br />NDOL Office of Legal Connsel <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 />Liable Person: <br />Address: <br /> <br />Russ's Car Wash Inc. <br />1304 West Second.Street Grand Island NE 68801 <br /> <br />NDOL Serial No.: LAB-0054-2008 To be filed with the Register of Deeds in the foUowio2 Counties: <br />NDOL Acct. No.: 0207337005 Hall ! I <br />Federal In No.1 SSA No.: 47w0688292 I I <br /> <br />This State Tax lien is issued for unpaid combined taxes (Neb. Rev. StD.t. ~~48-6S7 and 48-(64) or payments in lieu of contributions (Neb. Rev. Stat ~48-660.01) pursuant to the <br />Uniform State Tax Lien Registration & Enforcement Act (Neb. Rev. S14t ~77-390 1, el 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 tiom this 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 cOlDlty/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 I Penalty Through Subtotal <br /> Of Contributions Due 3/2712008 <br />312007 3/12/2008 $460.27 $0.00 I $33.58 $ 493.85 <br />4/2007 3/12/2008 $lOi01 I . ~~+ $2.84 $ 105.85 <br /> I I <br /> $ 0.00 <br /> 1- I $ 0.00 <br /> --- i <br /> $ 0.00 <br /> I <br /> $ 0.00 <br /> $ 0.00 <br /> - <br /> , $ 0,00 <br /> ! $ 0.00 <br /> I $ 0.00 <br /> I <br /> $ 0.00 <br />- <br /> $ 0.00 <br />TOTAL Combined Tax or Payment in Lieu of Contributions Due (under this lien only): S 599.70 <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 tbe employer or person bas failed to pay the amount due after demand. ' <br />FERNANDO LECUONA <br /> <br />Date: April 4. 2008 <br /> <br />By: <br /> <br /> <br />B, Legal Counsel <br />S A. UKlNSKI, Legal CODDSel <br />SSELL BARGER, Legal Counsel <br /> <br />T:\DOCUMENTS\FORMS\Liens\Original.doc <br /> <br />RETURN Fll..ED COPIES TO: Nebr. Dept. of Labor - LEGAL <br />P.O. 80194600 <br />Lincoln, NE 68509-4600 <br /> <br />NEBR. DEPT. OF LABOR <br />CHARGE ACCT. #147~) <br />\,\1 <br />