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<br />12/29/2008 MON 8:04 FAX 402 471 4429 UCC SECRETARY OF STATE ~~~ Hall <br /> <br />14J006/006 <br /> <br />n~ <br />V <br /> <br /> <br />200810440 <br /> <br />9908580700-8 Pgs: 1 <br />FLORES ERIKR G <br />Filed: 12/24/2008 02:39 PM <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 />Liable Person: __ Efi!al G. Flores dba Y A J R D~all <br />Address: 2013 Cottage Street Grand Island NE 68803-2107 <br />NI!OL Serial No.:__ _~-_Q.~_66-2008 __._ 1'0 ~e fd~ with the Reg!!.~~ of De~~!.in _~~~l?!I~Wing Counties: . <br /> <br />F~ral~~~l~-~~J*Eff]--'--- J:JJtJ,L- --~-'---"-'----r-'-------'-- <br /> <br />This State Tax Lien is issued for unpaid combined taxes (Neb. Rev. SIal. ~~48-657 and 48-664) or payments in lieu of contributions (Neb. Rev. SIal. <br />~48-660.0I) pursuant to the Unifonn State Tax Lien Registration & Enforcement Act (Neb. Rev. SIal. ~77-390 I, eI seq.). Notice is given that combined taxes <br />or payments in lieu of contributions, interest (computed at 1.5% per month), and penalties are due from this employer or person and remain unpaid after <br />demand. These combined taxes or payments in lieu of contributions constitute a lien for any and all personal property and real property in the county/counties <br />named, belonging to the employer or person, whether now owned or hereafter acquired. <br /> <br />;- <br />i <br /> <br />Interest <br />Qtr / Y I D t A d I Combined Tax Or Payment In Lieu P Ity Th h Subtotal <br />. r. a e ssesse' Of Contributions Due ena roug <br />11/25/2008 <br />412004 11110/2008 I' $70.00 $25.00 $48.11 I $ 143.11 <br />=~=r::::l=====~I~J- - :~::I- -~~~ <br /> <br />._~/2005 _ -Tl1l10/2008 I $455.0~_~..__..___,__ $25.00 $251.~~_~, $ 7~1.46 <br />4/2005 -+11110/2008 $455.001 $25.00 ! $230.82 _I $ 710.82 <br />- 1I20~6 t~l0J2oo8 $1,014.0~ =- $25.00 ~9.91 $1,508.91 <br />2/2006 11110/2008 $1,014.00 $25.00 $423.92 $1,462.92 <br />312006 =cJEI07io08 $1,014.001-- . $25.00 $377.93 -$1,416.93 <br />4/2006 _~gI~io08 $l,Ol~.O~L_ $25.00 $331.93 - . $1,370.93 <br />112007 L 11/10/2008 $918.0~ $25.00 $260.23 $1,203.23 <br />-Z/2007-1 11110/2008 -$918.00-" $25.00 $218.59 I $1,161.59 <br />3/20071 11/10/2008 r- __ $9~8.0~ $25.00 ......E7"'6.%j $1,119.96- <br />4/2007 I 11/10/2008 I $918.0~_ $25.00 $135.32 $1,078.32 <br />112008 11/1012008 $972.00 ~25.oo $100.15 -51,097.15 <br />~2008 11110!20~ $972.00 $25.~0 $56.071 ~!2~3-:Q?_ <br />$ 0.00 <br />TOTAL Combined Tax or Payment in Lieu of Contributions Due (under this lien only): $15,583.22 <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 LE UONA, ill <br />Co <br /> <br />Date: December 24, 2008 <br /> <br />By: <br /> <br /> <br />(]J <br /> <br />T:\DOCUMENTS\FORMS\Liens\Original (12+qtrs).doc <br />