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05/20/2009 OPED 15:14 PAX 402 471 4429 UCC SECRETARY OF STATE ~-~~ Hall <br />(~`~ ~ Sso1 <br />Department of the Treasury -Internal Revenue Service <br />Form ddb (Y)(c) <br />lNev. February 2004) No~t~ce of Federal Tax Lien <br /> <br />Area: Serial Number <br />For O NE Soo v- 5l~M Jnhn p 6~1Y ., <br />ucc FT4 <br />SMALL BUSINESS/SFsLF EMPLQYED.AREA #4 <br />Lien Unit Phone: (800) 913-6050 544612109 <br />As provided by section d321, b322, 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 99095971855 Pgs ; f <br />a demand for payment of this liability, but it remains unpaid. Therefore, wI~~IS SHOE qNb BOOT INC A c <br />Filed: 05/20/2009 01;~ pM <br />there is a lien in favor of the United States on all property and rights to <br />property belonging to thix taxpayer far the amount of these taxes, and <br />additional penalties, interest, and costs that may accrue. <br />Name of Taxpayer WILLIS SHOE AND BOOT INC a Corporate n <br /> 200903939 <br />Residence 379 N WALNUT ST <br />GRAND ISLAND, NE 6$801-4513 <br />1MP~RTANT RELEASE INFORMATION: For each assessment listed below, <br />unless notice of the lien is refiled by the date given in cplumn (e), this notice shall, <br />on the day following such date, operate as a certificate of release as defined <br />in IRC 6325(a-. <br /> Tax Period Date of last Dayy for Unpaid Balance <br />Kind of Tax Ending Identifying Number Assessment Refiling of Assessment <br />(a) Cb) (c) (d (e) (~ <br />941 12/31/2008 47-0$21358 04/06/2009 05/06/2019 57$7.89 <br />Place of Filing <br />Register of Deeds <br />Hall POBOX 1692 <br />Grand Island, NE 68802-1692 <br />Total I $ 5787.89 <br />This notice was prepared and signed at <br />the <br />CHICAGO, 1L <br />2009 <br />on this, <br />Signature ~ y i/~ REVENUE OFFICER 24-10-1744 <br />for PATRICK J KELLOGG (308) 384-4850 <br />06th day of May <br />I~J006/p08 <br />(NOTE: Certificate of officer authorized 6y law to take acknowledgment is not essential to the validity of Notice of Federal Tax lien <br />Rev. Rul. 71-466, 1971 - 2 G.B- 409) Form 668(Y)(c) (Rev. 2-2004) <br />Part 1 - Kepc By Recording Office CAT. NO 60025X <br />