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'/06/2011 WED 14:50 FAX 402 471 4429 UCC SECRETARY OF STATE -+y-� 8a11 <br />� <br />20�.�05005 <br />�J007/008 <br />11L16 AM <br />STATE TAX LIEN ❑ NEBRASKA DEPARTMENT OF LABOR <br />� ORiGIN�►1. <br />NDOL Ofiice of Legal Counsel <br />P.O. Bog 94600 <br />Lincoln, NE 68509-4600 <br />Telephone - (d02) 471-9912 <br />FAX - (402) 47 1-9917 <br />.amp�oyer or <br />Liable Person: Triple C Transport LLC <br />Address: 147 E. Roberts St Grand Tsland NE 68803-2159 � � � <br />NDOL Serial No.: LAB-0139 2011 To be fded with the R ister of Deeds in the followin Counties: <br />NDOL Acct No.: 0335068000 HaII <br />Federal ID No. / SSA No.: 27-2014592 <br />This State Ta�c Liea is issued for unpeid combined � (Neb. Re►+. StaG §§48-657 aod 48-664) or payments in lieu of contributions (Neb. Rev Srat. §48-660.OI) pvrsuaot <br />to the Uniform State Tax Lien Registrati�on & Enforcement Act (Neb. Rev Stai. §77 3901, e� seg.): Notice is given that combine� t�ces or payments in lieu of <br />contnbu6ons, iate�st (computed at 1.5% per month). and penelties are due from this employer or person end remain unpaid after demand These wmbined taxes or <br />payments in lieu of contributions constitute a lien for any and all pe�soaal property and real properiy in the county/coundes named, belongiag to the employer or person, <br />wheti�er now owned or hereafter acquir�l. <br />Qtr. / Yr. Date Assessed <br />3/2010 6/10/201I <br />4/2010 6/IO/2011 <br />Combined Tax Or Payment Ia Lieu <br />Of Contributions Dae <br />$10,571.38 <br />$9,089.89 <br />TOTAL Combined Tax or Peyment in Lieu of ContribuHons Due (under this lien only): <br />Interest <br />Penalty Through Subtotal <br />6/25/2011 <br />$0.00 $1,235.17 <br />$0.00 649.79 <br />$11,806.55 <br />$9,739.68 <br />$ 0.00 <br />$ 0.00 <br />$ 0.00 <br />$ 0,00 <br />$ 0.00 <br />$ 0.00 <br />$ 0.00 <br />$ 4.00 <br />$ 0.00 <br />$ 0.00 <br />SZ1,546.Z3 <br />I certify that the Nebraska Department of Labor has complied with the Employment Security I,aw of the State of Nebraska in the <br />determination af t6e amount due, and the employer or person has failed to pay the amouat due a emand. <br />CATHERINE D. I,,�� <br />Date: 7uly 6, 201 I <br />T:�DOCUMEN'fS1FORMS1Liens\Original lien.docx <br />RETURN FILED COPIES TO: Nebr. Dept of Labor - LEGAL <br />P.O. Box 94600 <br />Liacoln, NE 68509-460U <br />Agency Legal Counsel <br />NSKI, Legal Counsel <br />NEBR DEPT. OF LABO <br />CHARGE ACCT. #1476 . <br />