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01/26/2005 17:07 FAX 14024714429 NEBRASKA UCC Q 003 /006 <br />200500696 <br />STATE TAX LIEN • NEBRASKA DEPARTMENT OF LABOR NDOL Office of Legal Counsel <br />X ox><cnv�,1 P.O. Box 94600 <br />Lincoln, NE 68509 -4600 <br />Telephone - (402) 471 -9912 <br />FAX - (402) 471 -9917 <br />Employer Name: Midwest Transfer Inc. f/d/b /a E N T Transfer <br />Address: 1009 West So. Front Street Grand Island NE 688014713 <br />NDOL Serial No.: LAB -0014 -2005 To be filed with the Register of Deeds in the following Counties: <br />NDOL Employer Acct. No.: 20 91740009 Hall -- <br />Federal ID No. / SSA No.: 47- 0843358 �"- <br />I + <br />This State Tax Lien is issued for unpaid combined taxes (Neb. Rev. Star §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. SW §77-390 1, et seq.). Notice is given that combined taxes or payments in lieu of <br />contributions, interest (computed at 1.5% per month), and penalties are due from this employer and remain unpaid after demand. These combined taxes or <br />payments in lieu of contributions constitute alien 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 />j Combined Tax Or Payment In Lieu ? Merest <br />Qtr. / Yr. Date Assessed <br />Of Contributions Due Penalty ( 1/24/2005 j Subtotal <br />i <br />3/2001 — 12/9/2004 $52.50 1 $25.00 1 $30.57 $ 108.07 <br />4/2001 12/9/2004 $52.50'----- - - - -T— - - -- -- <br />_ _ _ $25.00 ; $28.19 �— $ 105.69 <br />1/2002 j -- 12/9/2004 `'; $52.50 $25.00 _ ,— ^�- - - - - -- <br />( $25.88 $ 103.38 <br />- $ 0.00 <br />- -- — _ $ 0.00 <br />s <br />i i $ 0.00 <br />-- - - -� -- ' . -- $ 0.00 <br />_$ 0.00 <br />1 <br />+ <br />$ 0.00 <br />+ $ 0.00 <br />0.00 <br />$— <br />0.00 <br />TOTAL Combined Tax or Payment in Lieu of Contributions Due (under this lien only): $ 317.14 <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 />Commissioner of /Labor <br />Date: January 25, 2005 By- <br />JOHN H. ALBIN -or- THOMAS A. UKINSKI <br />Agency Legal Counsel Legal Counsel <br />G <br />RETURN FILED COPIES TO: Nebr. Dept. of Labor - LEGAL NEB& DEPT. OF LABOR <br />P.O. Box 94600 CHARGE ACCT. #14765.. <br />i.inrnln.lVF. fdi5119 -dGall <br />