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08/05/2010 THU 14:12 FAX 402 471 4429 UCC SECRETARY OF STATE ~yy Ha11 <br />~' <br />STATE TAX LIEN <br />H ORIGINAL <br />201005531 <br />NEBRASKA DEPARTMENT OF LABOR <br />X002/005 <br />HE Sec a! ;kak• Jahn p 6dlt - I1[C STL <br />9910633956-8 <br />CpPPEtt EAGLE BRt:WING CO P9s: 1 <br />Filed: 08!05/2010 11:18~AMLC <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 />Employer or <br />.______~__.___..__ Liable Person: _Copper Ea le Brewing~Co. LLC ____. <br />^~- Address: ~ 120 E. 3`a S ~Grand Island NE 68801 ~~~~~"'~""`~`~~-~~-w~~~_~- ~ --____.._____._.______.____,_.._._.__._. <br />_ ___ NDOL Serial N_o.: _LA_8-0136-2010 _ To be filed with the R_e ster of Deeds in the followin Counties: <br />_ ~_ ND_O_L Acct. No :~ 0290535003 Hall ~~ ~~~ ~~~ _ T <br />_~__.__~._.._.~..~_____ _ ~ __. ____ ~ ~_._.~ ~`._._.__.__r <br />Federal ID No. /SSA No.: 47.0829929 `"`- -~----- .-_..__.___.._.__ <br />This State Tax Lien is issued for unpaid combined taxes (Neb. Rev. Slar. §p48-657 and 48~i64) or payments in lieu of contributions (Neb. Rev. 3rat. X48-660.tl I) pursuant <br />to the Uniform State Tax Lien Registration & Enforcement Act (Neb. Rev, Sipt. $77-3901, et seg.). Notice is given that combined taxes or payments in lieu of <br />contributions, interest (computed at 1,5% per month), and penalties arc due from this employer or person and rctnain unpaid 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 or ptxson, <br />whether now owned or hereafter acquired. <br />Qtr. / Yr. ~ Date Assessed ~ Combined Tax Or Payment In Lieu <br />Of Contributions Due <br />4/2002 I 7/12/2010 ~ - $513.98 <br />_.......,..__,_,.._..._._........__._._._....___._...____...__i.._._.________..~ _____.~_~..~____~~. <br />1/2003 ~ 7/12/2010 ` $274.54 <br />TOTAL Combined Tax or Payment in Lieu of Contributions Due (under this lien only): <br />$ 000 <br />$ o.oo <br />~- $ o.on <br />$ ^o:oo <br />o.oo <br />$1,$39.29 <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 />Comm~'paer of Labor <br />Date: August 5, 2010 ay; ~ ~ <br />xOHN H. ALBIN, Agency Legal Counsel <br />T:\l]OCUMENTS\FORM5\Liens\Original tien.doex THOMAS A. UKIN$1CI, Legal Counsel <br />RETURN FILED COPIES TO: Nebr. Dept. of Lobar -LEGAL NEBR. DEPT. OF LABOR <br />P.O. Box 94600 CHARGE ACCT. #1476$ <br />Lincoh~, NE 68509~b00 <br />Interest I <br />Penalty ~ Through ~ Subtotal <br />t 7/27/2010 ! <br />$0.00 <br />4- $692.77 <br />--_~._-. j <br />$1,206.75 <br />A <br />$0.00 <br />_.~._.. $358.00 <br />_~.._..._.... ~ _ <br />m.__ <br />- - $ 6 <br />32.54 <br />~.._._ <br />~~~ <br /> <br />__ <br />~.._~~.._. <br />_. _ <br />__M.~.._.... <br />,.. <br />. <br />$ 0.00 <br />~---._-_ <br /> ~- 0.00 <br /> <br />~ I $ 0.00 <br /> <br />