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<br />03/06/2009 FRI 14:49 <br /> <br />FAX 402 471 4429 UCC SECRETARY OF STATE ~~~ Hall <br /> <br />12J003/004 <br /> <br />otb <br /> <br />200901696 <br /> <br />~11.IIIllrIr r 11'll <br /> <br /> <br />9909569150-2 pgs: 1 <br />CERVRNTES MiCHELLE <br />Filed: 03/06/2009 02:29 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 />Jt ORIGINAL <br /> <br />Employer or <br />____..._.___ Liable P~!!m:._......M(9E.~!!.~ Ce~~ntes d/bla Speedt.Roo.f~&.___ <br />Address: 116 E. Hwy. 30, Grand Island, NE 68802 <br /> <br />______~DOL Se!!~l N~~_+_~_~~Q~Z~20.Q~__~ .--I4!.. be_!!~c:.~ Wi!!1_t!~~Tegister_of Dee~_~~-.!~~~U~~i~ C~.~~.~~.~___ <br />NDOL Acct. No.: I 0324936001 Hall I <br />---.F";deral ill No. TSSA''N~:~T16:i747404----'----- -.-------~-----.~--r-------.-.-..----- <br /> <br />This State 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 I) pursuant to the <br />Unifonn State Tax Lien Registration & Enforcement Act (Neb. Rev. Stat. ~77 -390 1, et 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 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 />! I Interest <br />Date Assessed i Combined Tax Or Payment In Lieu I P Ity Th h <br />! Of Contributions Due I ena roug <br />i 1/29/2009 <br /> <br />3/2008 I 1/14/2009 I $3,240.00 I $60.00 I $143.76 i $3,443.76 <br />,----.~~~......._-~~..~~.~t_~-.....~...,--,~~~~~...~.~,--.~.,~'~!__~_~'.~__~~_'~'r___~___rr___"___~_~~'__~~'~'~'_L'".~~~~~~-l-~~~~-~~--~......f~'-~---'-~'".~-'-"-'-'-"-~'-T'-~~__~.n_"'M"'.'''''''''.~ <br />~_~_~,~".._ <br />! i i i I $ 0.00 <br />--_._.._..._._--_.__._-_._+-_..._....._.._-~--~...._.__..............,.-.....--.----..---------...-.-.--.-...-....---........-.........._..+-_._..-_....._...~_.........--,_..............,,,..._...._- <br />.........._--....-.+..-....-------..------..-........----....-.. <br />i! l I 1 $ 0.00 <br />.....___......___...._..~...._______L__.._...."................._..._.................................-................--.......---..---..--------....-----..-...-......-----..-.-.r..~-.--.~---.---.-. <br />-~...---r-..---..-..-..----..----..----+..-........................-..--------------.-..-...-. <br />!! : i I $ 0.00 <br />....---------~--...........---.r...........-..--....--------------...---r--------....--...."-..,,.-----....-.-~---.---...-....---..-.....--.-..-..--r..---..--.........-~...-....-..-.-..r...-.-...-.-. <br />--.--..-....-....-r---.--.....""......-......i.-o .00-." <br /> <br />--...----..-----.---....---r---.......-...............-...-...................../..-...--.---....-.......---.-----...-..-.--..........--...-.-.---.-.-.--i-.--.----~------J--------------..-.......-.r. <br />...-......-..-..........$......000.-.. <br /> <br /> <br />===t-~~ <br />==-=-~==-~ ~~=t1[ <br /> <br />i i Ii: $ 0.00 <br />.....--.--...-....-.....----------l-----..--................-.--...-...-1...--...--..-..-..-..-.."'..---------........-----....------.-.-...r--.-......--.----.-......-...1....-..-.....---............ <br />...---....-1.......-.....---.......-.........-------...-.-. <br />1 i I I i $ 0.00 <br />TOTAL Comb~n~d Tax or Payment in Lieu of Contributions Due (under this lien Onl;): . I $3,443.76 <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 />CATHERINE D. LANG <br />Commissi <br /> <br />~._____.._.~_...._..__"M~~Y~~_~~.~.~~~.n....__._.y,,_~..~~~ <br /> <br />Qtr. 1 Yr. <br /> <br />Subtotal <br /> <br />Date: March 6, 2009 <br /> <br />By: <br /> <br /> <br />T:\OOCUMENTS\Liens\State Tax Liens\03 20000 000'()3 2493600 I 2.do; <br /> <br />RETURN FILED COPIES TO: Nebr. Dept. of Labor - LEGAL <br /> <br />P.o. Box 94600 <br />Lineoln, NE 68509-4600 <br /> <br />NEBR. DEPT. OF LABOR(\ <br />CHARGE ACCT. #147~ j <br />