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Form 668 (Y)(c) <br />(Rev. February 2004) <br />14583 <br />Department of the Treasury - Internal Revenue Service <br />Notice of Federal Tax Lien 2 014 0 013 <br />Area: <br />SMALL BUSINESS/SELF EMPLOYED AREA #4 <br />Lien Unit Phone: (800) 913 -6050 <br />Serial Number <br />976393513 <br />For Optional Use by Recording Office <br />N E iefi of ste J.Mw P Sale - UCC FTL <br />, , i <br />I <br />I I 114 <br />i <br />9 ' <br />8914728543 -6 tea 1 <br />Fin d 0 110012014010,41CAM coR <br />As provided by section 6321, 6322, and 6323 of the Internal Revenue <br />Code, we are giving a inotke that taxes (including interest and penalties) <br />have been assessed against the followingnamed taxpayer. We have made <br />a demand for payment of this liablity, but it remains unpaid. Therefore, <br />there is a lien in favor of tine United States on all property and tights to <br />property belonghtg to this taxpayer for the amount of these taxes, and <br />additional penalties, Interest, and costs that may accrue. <br />Name of Taxpayer WILLIS SHOE AND BOOT INC <br />a Corporation <br />Residence 379 N WALNUT ST <br />GRAND ISLAND, NE 68801 -4513 <br />IMPORTANT RELEASE INFORMATION: For each assessment listed below, <br />unless notice of the lien is nailed by the date given in column (e), this notice shall, <br />an the day following such date, operate as a certificate of release as defined <br />in IRC 6326(x). <br />Kind of Tax <br />( a) <br />Tax Period <br />Ending <br />(b) <br />Identifying Number <br />(c) <br />Date of <br />Assessment <br />(d) <br />Last 1�r for <br />Refilna <br />(e ) <br />Unpaid Balance <br />of Assessment <br />(f) <br />6721 <br />12/31/2010 <br />47- 0821358 <br />11/04/2013 <br />12/04/2023 <br />11677.52 <br />, <br />Place of Filing <br />Register of DeedB <br />Hall, POBOX 1692 Total <br />Grand Island, NE 68802 -1692 <br />$ 11677.52 <br />Jan. 8 2014 3.22PM NE Secretary at State — UCC <br />This notice was prepared and signed at _CA, IL <br />on this <br />the 31st day of December 2013 <br />Signature <br />for DANIELLE L MOELLER <br />Title <br />REVENUE OFFICER <br />(402) 473-46'75 x2912 <br />No. 2733 P. 2/2 <br />24 -10 -1720 <br />(NOTE[ Certificate of officer authorized by law to take acknowledgment is not essential to the vatdlty of Notice of Federal Tex lien <br />Rev. Rul. 71 - 4$9, 1971 2 C.B. 409) Farm 666(Y)(e) (Rev. 2 -2004) <br />Put 1 - Kept Gtr Retordbs Office CAT. NO 60025X <br />