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01/10/2005 16:15 FAX 14024714429 NEBRASKA UCC 0 002/002 <br />V� <br />200500289 <br />N[ s.c of 54.4. - U[C STL <br />9905371135 --0 Pas: 1 <br />D P H INC- <br />Filod: 01/10/2005 01:42 PM <br />STATE TAX LIEN • NEBRASKA DEPARTMENT OF LABOR <br />NDOL Office of Legal Counsel <br />P.O. Box 94600 <br />X ORIGMAL <br />Lincoln, NE 68509 -4600 <br />Telephone - (402) 471 -9912 <br />FAX - (402) 471 -9917 <br />Employer Name: D P H Inc. f/d/b /a Harrisons Downtown <br />Address: 2711 Riverside Drive Grand Island NE 68801 <br />NDOL Serial No.: !'LAB-0008-2005 <br />To be fled.with the Register of Deeds in the following Counties: <br />NDOL Employer Acct. No.: 0283231001- <br />: <br />Hall s <br />Federal ID No. / SSA No.: ! 47- 0830406 <br />This State Tax Lien is issued for unpaid combined taxes (Neb. Rev. Stat. §48 -657) or payments in lieu of contributions (Neb. Rev. Stat. §48- 660.01) pursuant <br />to the Uniform State Tax Lien Registration & Enforcement Act (Neb. Rev. Stat §77 -3 901, et seq.). Notice is given that combinedtaxes or payments in lieu of <br />contributions, interest (computed at 1.5% per month), and penalties are due from this employer and remain unpaid <br />after demand. These combined taxes or <br />payments in lieu of contributions constitute a lien for any and all personal property and real property in the county /counties named, belonging to the employer, <br />whether now owned or hereafter acquired. <br />Combined Tax Or Payment In Lieu <br />Qtr. / Yr. Date Assessed ! ; Penalty <br />Interest j <br />Through Subtotal <br />Of Contributions Due <br />j <br />1/5/2005 <br />4/2001 j 12/21/2004 $1.67 $0.00 <br />$0.88 $ 2.55 <br />1/2002 i 12/2112004 1 $5.97 ; $0.00 ; <br />S2.89 j $ 8.86 <br />2/2002 — 12/21/2004 - — $890.33 j $0.00 <br />— <br />$390.21 <br />- <br />3/2002 j 12/21/2004 - -- $271.86 $25.00 <br />106.82 i $ 403.68 <br />! $ 0.00 <br />0.00 <br />: <br />0.00 <br />{ ; <br />$ 0.00 <br />t--- - - - - -- � <br />- - - - - -! - -- $ 0.00 <br />— $ 0.00 <br />! 0.00__ <br />{ <br />$ 0.00 <br />TOTAL Combined Tax or Payment in Lien of Contributions Due (under this lien only): <br />$1,695.63 <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 has failed to pay the amount due after demand. <br />FERNANDO LECUONA, III <br />Commissio e o <br />Date: January 10, 2005 By: <br />HN A. -or- THOMAS A. UKINSKI <br />gency Legal Counsel Legal Counsel <br />RETURN FILED COPIES TO: Nebr. Dept. of Labor- LEGAL <br />P.O. Box 94600 . <br />Lincoln. NF. 61509 -46Ml <br />NEBR. DEPT. OF LABOR <br />CHARGE ACCT. #14765 <br />