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06/26/2013 WED 14:22 FAX 402 471 4429 UCC SECRETARY OF STATE <br />Residence <br />Place of Filing <br />the <br />Form 668 (Y)(c) <br />(Rev. February 2004) <br />Area: <br />SMALL BUSINESS /SELF EMPLOYED AREA # <br />Lien Unit Phone: (800) 913 -6050 <br />Name of Taxpayer WILLIS SHOE AND BOOT INC <br />a Corporation <br />Kind of Tax <br />(a) <br />940 <br />Signature <br />3758 <br />for DANIELLE L MUELLER <br />Department of the Treasury - Internal Revenue Service <br />Serial Number <br />379 N WALNUT ST <br />GRAND, ISLAND, NE 68801 -4513 <br />Tax Period <br />Ending <br />(b) <br />12/31/2012 <br />13th day of June <br />Identifying Number <br />(c) <br />47- 0821358 <br />Register of Deeds <br />Hall POBOX 1692 <br />Grand Island, NE 68802 -1692 <br />Notice of Federal Tax Lien 201305117 <br />2013 <br />Date of <br />Assessment <br />(d) <br />05/13/2013 <br />CHICAGO.,_ IL <br />944740313 <br />As provided by section 6321, 6322, and 6323 of the Internal Revenue <br />Code, we are giving a notice that taxes (including interest and penalties) <br />have been assessed against the following -named taxpayer. We have made <br />a demand for payment of this liability, but it remains unpaid. Therefore, <br />there is a lien in favor of the United States on all property and rights to <br />property belonging to this taxpayer for the amount of these taxes, and <br />additional penalties, interest, and costs that may accrue. <br />IMPORTANT RELEASE INFORMATION: For each assessment listed below, <br />unless notice of the lien is refiled by the date given in column (e), this notice shall, <br />on the day following such date, operate as a certificate of release as defined <br />in IRC 6326(a). <br />Hall <br />Last Day for <br />Refihng <br />(e) <br />06/12/2023 <br />Title <br />REVENUE OFFICER <br />(402) 473 -4675 x2912 <br />For Optional Use by Recording Office <br />11111 1111111 <br />9913717 - 9 <br />Pgs: 1 <br />WILLIS 06/2 01C <br />:2 5 P M COR <br />Filed: <br />Total $ <br />Unpaid Balance <br />of Assessment <br />(f) <br />4919.92 <br />4919.92 <br />20 03/ 0 04 <br />24 -10 -1720 <br />(NOTE: Certificate of officer authorized by law to take acknowledgment is not essential to the validity of Notice of Federal Tax lien <br />Rev. Rul. 71 -466, 1971 2 C.B. 409) Form 668(Y)(c) (Rev. 2 -2004) <br />Part 1 - Kept By Recording Office CAT. NO 60025X <br />