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05/07/2008 WED 15:12 FAX 402 471 4429 UCC SECRETARY OF STATE ~~~ Hall 121003/004 \)~ ME s.c af ,...., Ja~" A...'. - UCt STL 9908558970-1 Pgs; 1 SNOW SHACK OF NEBRRSKA INC. Filed: 05/07/200B 03,01 PM 200803974 . NDOL Office of Legal Counsel P.O. Box 94600 Lincoln, NE 68509-4600 Telephone - (401) 471-9911 FAX - (402) 471-9917 ... STATE TAX LIEN. NEBRASKA DEPARTMENT OF LABOR 1 OmGINAL NDOL Serial No.: LAB-0075-2008 To be fded with the Re2ister of Deeds in tb!ll~llowing Counties: ~_._ - NDOL Acct. No.: 0310360005 Hall.1 ______ Federal ID No./ SSA No.: 26-0071700 I I Employer or Liable Person: Address: Snow Shack of Nebraska Inc. d/b/a The Snow 1618 Allen Ave. Grand Island NE 68803 This State Tax lien is issued for unpaid combined taxes (Neb. Rev. Sial. U48-657 and 48-664) or payments in lieu of contributions (Neb. Rev. Sial. fi48-660.0 I) pursuant 10 the Unifonn State Tax lien Registration & Enforcement Act (Neb. Rev. Sial. fi77-390I, 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 or person llIld remain unpaid after demand. These combined taxes or payments in lieu of contributions canstitute a lien for any and all penlonal property and real property in the county/counties named, belonging to the employer or person. whether now owned or hereafter acquired. I Combined Tax Or Payment In Lieu Interest I Qtr./Yr. Date Assessed Penalty . Through Subtotal Of Contributions Due 4/24/2008 312005 4/24/2008 $29.22 $0.00 $13.05 I $ 42.27 4/2005 4/24':008 i $0.00 $25.00 .~$o.ooT-----------$ 25.00 - 2/2006 4/24/2008 . $133.38 $25.00 $41.62 1---s200~OO ---.. --l---------~- 3/2006 4/9/2008 $202.80 $25.00 $54.09 ~ $ 281.89 --~-- -- 412006 4/24/2008 SO.OO $25.00 $0.00 $ 25.00 1/2007 4/24/2008 $0.00 $25.00 $0.00 $ 25.00. 2/2007 4/24/2008 $142.88 $25.00 I $18.88 $ 186.76 --- - .--- 1-----.-.- 312007 4/9/2008 $162.00 $25.00 $14.06 $ 201.06 -- --.. -- 4/2007 4/24/2008 SO.OO $25.00 $0.00 $ 25.00 $ 0.00 . - $ 0.00 - $ 0.00 TOTAL Combined Tax or Payment in Lieu of Contributions Due (under this lien only): $1,011.98 I 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 or person bas railed to pay the amount due after demand. FERNANDO LECUONA, m By, ~~C/'--Q JQBN H. ALBIN, Agency Legal Counsel . THOMAS A. UKlNSKI, Legal Counsel W. RUSSELL BARGER, Legal Counsel May 7, 2008 Date: T:\DOCUMENTS\FORMS\Liens\Original.doc RETURN FILED COPIES TO: Nebr. Dept. of Labor - LEGAL P.O. DOl 94600 Uncoln. NE 68509-4600 NEBR. DEPT. OF LABOR CHARGE ACCT. #147M.fJ) ,,-'J