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<br />08/13/2008 WED 14:20 FAX 402 471 4429 UCC SECRETARY OF STATE ~~~ Hall <br /> <br />1lI002/002 <br /> <br />00 <br /> <br />200806998 <br /> <br /> <br />ST ATE 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 />__..___._.......__......__....}~!!!!>le P.!~~l!~_._1-1.2.!l..&9}j!1:._gE!.~}_.9.i.9mah~}.!!~.:_._.____~_________~__._______._._______"'."'......._.........._._".__.._.._._._........__._....._.__""'._ <br />_____.____ <br />Address: 1816 Webb Road Grand Island NE 68803 <br />- .-------,---..-~J!.Q1.~!!"!~!~~..:.:--r.-.~~-Q!~?.::?gg-~-.---....-.-....-.-.........-!.~-!l.~.-~-~~~..~~~.-t.~~~rg.~s.~er_~.!}?_~!:.<!.~!I.':_t.~__!~~_l?~~E:g,.f~.!~!!~!=______ <br />-----F~d~-;;i'.ilil!~~.N~l:..~~~~+~~.~61;~~i;.-...-----'-..--....-...........R.9~g.1.~~-..........-.......-....-.-.---.i-l!~.!!..-.".......-.--.---.-.--..,,--.-+----~-....-.--...--.-----..-.... <br /> <br />This State Tax Lien is issued for unpaid combined taxes (Neb, Rev. Stat. ~~48-6S7 and 48-664) or payments in lieu of contributions (Neb. Rev. Stat. H8-660.0 I ) pursuant to the <br />Uniform State Tax Lien Registration & Enforcement Act (Neb. Rev. Stat. ~ 77 ..390 I, 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 from this employer or person and remain unpaid after demand. These combined taxes 01' 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 01' person, whether now owned or hereafter acquired. <br /> <br />'I Interest I' <br />I Combined Tax Or Payment In Lieu <br />I Date Assessed I Of Contributions Due Penalty Through I <br />I ! 7/22/2008 I <br />I I I I <br />1/2006 I 71712008 I $561.60 I $0.00 ! $225.37 i $ 786,97 <br />...._,,___.__________.._~_.l--____...._.._._._______._._._~--..._.._..._.___._.._,,__...._..____._.__..___.__..__.._.._.n...........,..........M._..."'._I.._..__..__...__............_.__._._......__. <br />-.....--.--...-..-....."...--...t-..-.---.----"'.--.---- <br />___..___~!,~~?..~_..."....__i--____?~?!~OO~_~L___.._..._._...__.___.....___...__"._~_____________.~_!.:!_,!."'j..-...--....--..-.-~~~~--..i..-.--.-----...-..!?:~~-~.........---..._____~....__!:~L.... <br />.-...-..-...!~~~?..?........-....+.-.-.--?~:~?..?.~--..---l....-...--.....--..---.-.----.....--..-.-.....--...-------~~!-~~~.....i.""'....._..".."..._,__~~~?.....I..."._.___.._~..:?..:9.!.~---.,,____ <br />__.__~~~~~2S._ <br />_....~~~~~.._....-.....~.. ..~-~;~;~~~: -.-+---..-...---...-----..--..---------------..-..i~~~~1~-..I.............-...-......-.-~-~.~.~."..!"..-"-.-.-.-..,,--.-H~~.~..-f.-----~__;2b11~"'" <br />--'''-''-'''2i200'7''---~ ..-.-717/2008-...-.--..t-...------..---..-.----..-~,..-.....-.---..-...-.-$7~63-..t--.-------~..-$o:o6--r------...$i.34'-~-"-"'''--.'._$-'' 8.97"- <br />~=~~~~~~?~~==.~=2!7EOO~==-.~~I~~~~==~~~~~~~~~~.==~~==~:.:==~==~::~~~~x~t~..~.:::.:~~~.::=~~?=r~~~.-=~~.=~=Ii~~~ .__.:.=-'.=~~=._.$"'-22~_-'~ <br />.---~~~~-~._-..-..-~-.-.~~;~~~i-.~---.-------.----..--......--...-..".-..-,...---.'m-.~~~~~.~.....f...................--'-"'-~~~'~'-l'--'--'-"--}~~~'~- -------i- :~::~ . <br /> <br />..-------....---.~..-.-_.-..-.i"-.--.---..-.--.-.!-.--...-.--...-...-....----"'...--..,............--..-."...-....-....-...-.....-..-..........I-....-...........--..--."''''-'''..!''..........-.-.-.- <br />"'-.-.--.--..---r----.--......---S-- 0.00'-' <br /> <br /> <br />=-=+===t===+-=:lo~ <br /> <br />i: i: I $ 0.00 <br />TOTAL Combined Tax or Payment in Lieu of Contributions Due (under this lien only): ! $1,750.31 <br /> <br />Qtr.1 Yr. <br /> <br />Subtotal <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 has failed to pay tbe amount due after demand. <br />FERNANDO NA, I <br />Commisso er 0 r <br /> <br />Date: August 13, 2008 <br /> <br /> <br />, Agency Legal Counsel <br />M . UKINSKI, Legal Counsel <br />SELL BARGER, Legal Counsel <br /> <br />T:\DOCUMENTS\FORMS\Liens\Original,doc <br /> <br />RETURN FILED COPIES TO: Nebr. Dept. of Labor ~ LEGAL <br />P.O. Box 94600 <br />Uneoln, NE 68509-4600 <br /> <br />NEBR. DEPT. OF LABOR <br />CHARGE ACCT. #147~ <br />