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10/27/2011 TgU 14:03 FAX 402 471 4429 UCC SECRBTARY OF STATE ��� Hall <br />�, <br />i <br />2011081 <br />NDOL Offlce of Lagal Coansel <br />P.O. Boz 94600 <br />Lincoln, NE 68509-4600 <br />Telephane - (402) 471-9912 <br />FAX - (44Z) 471-9917 <br />ST.�iTE TAX LIEN ❑ NEBRASKA AEPARTMENT OF LABOR <br />■ O1�tGnvAr. <br />Employer or <br />Liable Person: Lonnis Greuter d/6/a GSE Construction, Greuter Steel Erectozs <br />Address: 420 Roush Lane, Grand Island NE 68801 <br />NDOL Seruai No.: LAB-0264-2011 To be flled wifh the Re ' er of Deeds in the foMlowin Counties: <br />NAOL Acct No.: 0320038008 Hall <br />Federal ID No. / SSA No.: xiac Yoc8226 <br />This Stede Tex Lien is issued for ucipaid combined taxes (Neb. Rev. Stat. §§48-657 aad 48-664) or paymentc in li� of contributions (Neb. Rev. Stad. §48-660.01) paisuaat <br />to Che UaiPorm State Tax Lien Registrarion & Enforcanent Ac;t (Neb. Rev Sta� §77 3901, et s¢g.). No6ce is given �at combiaed taxes or paymeats im lieu of <br />�ntrilautions, itrterest (computed at 1.5% per mondr), end penalties are due from tluis eaaployer or person end remain unpaid a8et demand. These combiaed taxes or <br />pa}ar�e� in lieu of coutributioas corntitartc a Hen far aay and all petsonal propealy and real properiy in the countylcwmti� nemed, belonging w the anpioyer or peison, <br />whet6er now owned or hete�fter acquiced. <br />Qtr. / Yr. Date A.ss�ssed <br />4/2010 I0/4/20 <br />1/2011 10/4/2011 <br />2/2011 10/4/2011 <br />Combined Tag Or Paynnent In Lieu <br />Of Contributfons Due <br />$429.91 <br />$429.91 <br />$429.91 <br />TOTAL Combined Tax or Paymept in Lfeu of Contributions Due (ander tltia lien only): <br />�002/002 <br />Inter�t <br />Penalts► Throngh Snbtotal <br />10i1912011 <br />$25.00 <br />$55.32 <br />$36.45 <br />$16.96 <br />$ 510.23 <br />$ 491.36 <br />$ 47I.87 <br />$ 0.00 <br />$ 0.00 <br />$ 0.00 <br />$ 0.00 <br />$ 0.00 <br />$ 0.00 <br />$ 0.40 <br />$ 0.00 <br />$ 0.00 <br />$1,473.46 <br />I cettit� that the Nebraska Department of Labor has complied with the Employment Securfty Law of the State of Nebraska in the <br />deteruxination of the amonnt dne, and the employer or persoa has failed to pay tLe amoant dne after demand. <br />CAT'�RINE D. �-� <br />Date: October 27, 2011 <br />T:1DOC'UM�NTSIFORMS1L.ieas\Origival lien.docx <br />By: <br />RETURN FILED COPIES TO: Nebr. Dept of Labor - LEGAL <br />P.O. Box 9d6� <br />Lincoln,lVE 68509-4600 <br />�II�T, Agency Legal Caunsel <br />A. UI�N3HI, Legal Couasel <br />NEBR DFPT. OF LABOR <br />CHARGE ACCT #1476 <br />;. <br />,. <br />