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11/17/2010 WSD 14:08 FAX 402 471 4429 UCC SECRETARY OF STATS �yy H�11 <br />�� <br />201008595 <br />STATE TAX LIEN ❑ NEBRASKA DEPARTMENT OF LABOR <br />� O�t[cnvAt� <br />NDOL Ufiice of Legal Couasel <br />�.D. Bpx 94600 <br />Lincoln, NE 68509-4600 <br />Telephone - (402) 471-991Z <br />FAX - (402) 471-991,7 <br />�mployer or <br />Liable �erson: M S uarsd Desi s Inc. <br />Address: 412 W. 3 Grand Island NE 68801 <br />NDOL Serial No.: LAB-p230-2010 . To be frled with the R ister of Deeds in the fpllowin Counties: <br />NDOL Acct. No.: 0317275Q04 g�u , <br />Federsl ID No. / SSA No.: 20-3761641 <br />'t'his State Tax Lien is issued for unpaid combined taxes (Neb. Reu Sra� §§qg..657 and 48fi6{) or parymcnis iu lieu of wntri6uGons (Neb. Re►: S1at $�F8-660.01) pursuant <br />to the Uniforrn State Tax Lien Registration 8c Enforcement Act (Neb. Rev, Stat ¢77 39D1, et seg.). Notice is given dia[ eombin,ed tarces or payments in lieu of <br />contributions, interest (wmputed at 1,5°� per month), and penalties are due �irom this employer or person and remain unpaid after demand, These combined taxes or <br />payments in licu of contributions constitute a lien far �ny and ali personai prapwty and roa! propecty in the counry/counGes named, bclonging m thc employcr or person, <br />whether now owned or hereafter apquired. <br />Qtr, / Yr. Date Assessed <br />1/20]D 10/27/2p10 <br />2CZ010 10/27/2p 1 p <br />Combined Tax Qr Payment In Lieu <br />O[ Contributions Du� <br />$217.24 <br />$140.04 <br />TOTAL Cpm6ined �'ax or Psyment in �ieu of Contributioqs Due (under this lien only); <br />�002/pQ2 <br />riiad; 11 /17%2010 01 27 PM <br />0 <br />Interest <br />pR��,�t Through Subtotal <br />1`1/11/2010 <br />�ZS.00 �zo.ss <br />$25.00 $7.11 <br />$ 263.12 <br />$ 172.15 <br />$ 0.00 <br />$ Q.00 <br />$ o.on <br />� o.00 <br />$ O,OA <br />$ U.pO <br />$ U.00 <br />$ O.Op <br />$ O.�Q <br />$ 0.00 <br />S 435.27' <br />I certify that the Nebraska Department of Labor has complied with the Ernployment Secarity Law°af the State nf Nebraska in the <br />determinatian of the amaunt due, and the epn�ployer or person has lailcd to pay the amount due after demand. <br />CATH�RINT D. LADT+GG-� � <br />Date: November 17. 2010 <br />T:�DOCUMENTS�FARM51LiensWriginsl lien.dacx <br />y Legal Caunsel <br />Legal Counscl <br />�y: <br />RETURN FTLED COPIES TO: Nebr. Dept of Labor - LEGAL <br />P.O. Box 94GU0 <br />Lincoln, lYE b8SU9-4GOD <br />N�BR DEPT. O�' LABQR <br />CHARGE ACCT #14765 <br />. V <br />