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Q5/12/2011 THU 13:50 FAx 402 471 4429 UCC SECRETARY OF STATE -�y-� 9a11 <br />�� <br />1 <br />201103609 <br />�� <br />�OQ'�1004 <br />ucc sn • <br />� <br />� <br />� <br />STATE TAX LI�N ❑.NEBRASKA DEPARTMENT OF LABOR <br />S ORCGINAL <br />NDOL Off'ice of Legal Counsel <br />P.O. Bog 94600 <br />Lineoln, NE 685Q9-4600 <br />Telep6one - (402) 471-9912 <br />FAR - (40Z) 471-9917 <br />r.mpioyer or <br />Lia61e Person: V B Lea LLC dba Valentino's of Grand Island <br />Address: 2245 AT. Webb Road Grand Island NE 688003 <br />NDOL Serial No.: LAB-U 104-2011 To be filed with the R' ter of Deeds in the followin Counties: <br />NDOL Acct. No.: 0332041002 � <br />Federa[ ID No. / SSA No.: 26-4819005 <br />This State Tax Lien is i�aed for unpaid cmmbined t�c�s (Neb. Rev Stat. §§48-657 and 48-664) or paymems in lieu of contributions (Neb.liev. Swt §48-660.0]) pntsuant <br />W the Uniform State Tax Lien Registration & Enfarcemenf Act (Neb. Rev. Stat §77-3901, et seq.). Notice is given thak combined t�es or payments in lieu of <br />contributions, interrest (computed at 1.5% per month�, and penalti� are due &om t6is employer or person and remain unpaid after demand. These combined t�tes or <br />Payments in lieu of co�ributions constihrte a lien for any end a(1 p�sonal property aad r�l properiy in the cowny/coundes named, belonging to the employer or pecson, <br />whether now owned or hereafter acquired. <br />Qtr. / Yr. Date Assessed <br />3/2010 4/22l2011 <br />Combined Tag Or Payment In Lieu <br />Of Contribntions Due <br />$499.22 <br />TOTAL Combined Tag or Paymeat in Lieu of Contributions Due (uoder this lien only): <br />L►terest <br />Penalty Through Subtotal <br />5�7/2011 <br />$0.00 � $46.27 <br />$ 545.49 <br />$ 0.00 <br />$ O.QO <br />$ 0.00 <br />$ 0.00 <br />$ 0.00 <br />$ 0.00 <br />$ 0.00 <br />$ 0.00 <br />$ 0.00 <br />$ 0.00 <br />$ Q.QO <br />$ 545.49 <br />Y certify that the Alebraska Department of Lab�r has complied with the Employment Security Law of the State of Nebraska in the <br />determiaation of the amounE due, and the employer or person 6as failed to pay the araount due after demand. <br />CATI�RINE D. LANG — <br />Date: May 12, 20I 1 <br />T:IDOCU14fENTS1FORMS1Liensl0riginal lien.doqc <br />RETURN FILED COPIES TO: Nebr. Dep� of Labor - LEGAL <br />- P.O. Bos 94b00 <br />tincoln, NE 68509�d600 <br />BIN, Agency Legal Counsel <br />UKINSKI, Legal Counsel <br />NEBR DEPT. OF LABOR <br />CHARGE ACCT #1476 ' <br />ladi Ob/i2/2011 12:03 pih <br />