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07/08/2010 THU 12:03 FAX 402 471 4429 UCC SECR8TA1tY p1? STATT3 ~~~ Hall STATE TAX LIEN ~ OTttcTNAt, 201004684 NEBRASKA DEPARTMENT OF LABOR X002/002 N@ Sic of S!e!° Jphn q Gals - U[C STL 9810831773-T3 Pgs: 1 Fail d~ 07%08N2010T10L17 qM NDOL Office of Legal Counsel P.O. Box 94600 Lincoln, NE 68509-4600 Telephone - (402) 471-9912 FAX - (40Z) 471-9917 Employer ar _-----_.,~,~__ Liable Person: _Tri~le C Transport LLC__.-- N.n~.-~ ~-~""_..--., .T.~_~~..__._.____,_____.__._.._,~._._......._..~_____..._.___ Address: 201 N. Ix` St. Doniphan, NE 68832-1712 ~~""'~"' ,_~__,______y N'DOL Serial No.__ _LAB-Ol 14-2010_ ~~~~~ To_be filed with the Re Tster of Deeds i>n the followin Counties: _ _ 1VDOL Acct. No.: 031 S 107000 _ -~-~-~~--__m_'"'~"'~"`~ ~""- ~~'~'--- ---- _.~...._._____.,._._... ~Hall~ ~I Federal ID No. /SSA No.: 20-4973399 `~_ ~- --------_----~- ---.______....__.._.__ This State Tax Lien is issued for unpaid combined taxes (Neb. Rev. Smt. ~§48-657 and 48-664) or payments in lieu of contributions (Neb. Rev. Srat. ~48~60.01) pursuant to the Uniform State Tax Lien Rcgistretivn & Enforcement Act (Neb. Rev. Stat. p77-3901, et seq.), Notice is given that combined taxes yr 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 demand. 'T'hese combined taxes or payments in lieu of contributions constitute a lien for any and alt personal property and real property in the county/counties named, belonging [o the employer or person, whether now owned or hereafter acquired. i Combined Tax Or Payment In Lieu ~ Interest Qtr. / Yr. Date Assessed i penalty Through Subtotal ~ Of Contributions Due ~ i 7/1/zolo 4/2008 6/16/2010 __ $0.00 $0.00 $285.37 $ 285 37 1 2 __ ___._ ._ 2/x009 6/16/2010 .------_-.-__-_..~...____...__ ,______.-~__---..__._._.~... --m___.__._,___-.---_._.~-_..,..__..___...._-...._.__.__..____ $3,826.63 $0.00. $960.06 $4,786.69 009 6/16/2010 ~ - ......._._.._...,.,......_._._._.._ $1,887.Od $0.00 ---...-.-.---,~___._..._ .. .......__.___..._...._.__...~_~..___.__.._ $311.66 $2,19$.72 ~-._._._____.._.__ __..... _.....____.-......_...w_._......__._.~...,_.._.,__._.._..~-_.-._Y.._._._.~ .~.-_._......__._.__.._.__......_____......_. 3/2009 6/16/2010 1,856.63 ~ $O.pO ; $222.42 $2,079.05 4/2009 6/ 16/2010 ~~- $1,148.61 $0.00 ~ ~ $$5.51~`__~...___~..._..____ ._.-_._._...._...__.._._...."...__.~ __...___...__.~._.____--_--__.. $1,234.12 ... _._________.._.._...__.__._.__G._._____-___--_._-____.._.._~_.._______~.__.._._....._...._.........__..___-___._..._.._ __ _~ $ 0.00 _ .___.....__... ___.__ _ ~ 4_, $ W 0.00 ------._,T_..-_.____ --___-_..__-------.1~___ _,.......___..~._._.__._____ __.__ _.__-__._..~.._ _ ___--__-__--~. _.___._._._ ..._~. ---- ____._ _._____._._....-_________.__~..,_._ ~......_.__.._ ~ _.__ $ 0.00 .._....._..._....__._.._...._._._ ~ ..__..._. .,_...._._..._,..._..__..._. i _.._.._..__.__ _f ___ _..__.___ ._..._._.........~__..._____. ~ _".___~^.. ~`.~_ _I~__~...____._.__-_.__...-----.__.____.___._._._ _~...._..___.~..._-_..w__~_ .._.._w,...._.___...._...~_._..._._.._$ _0.00_. .._._.__ _~.___~.___.__..._..~.. $ _0.00 -- ~ -- ___.._~_----..__._._.__-__._..___.___~-_-__-_._____._.~-. ~-_`"~$ 0.00 TOTAL Combined Tax or 1'aymertt in Lieu of Contributions Due (under this lien only): i $10,583.95 i I certify that the Nebraska Department of Labor has complied with the Employment Security Law of the State of Nebraska in the determination of the amount due, and the employer or person has failed to pay the amount due after demand. CATHERINE D. LANG Date: July $, 2010 gy; T,\pOCUM ENTS\FORM$\Liens\Original lien.docx I~SIN; algency Legal Counsel A. UKINSKl, Legal Counsel RETURN FILED COPIES TO: Nebr. Dept. of Labor -LEGAL NEBR. DEPT. OF LABOR t?.O. Box 94600 CHARGE ACCT. #147 Lincoln, NR 68509~6tID