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11/p3/2010 4dEA 15:18 FAX 402 471 4429 UCC SBCRE�axX OF STATE ��� Hall <br />�� <br />FOrlll ��$ (Y�(�� <br />(Rev. February 2004) <br />Fnr <br />r <br />Department of the Treasury - internal Revenue S"` <br />Notice of Federal Tax Lien � <br />'`'���; Serial Number <br />SMALL BU$�NE88/SELF ENIFI,pXLD A},?SA #4 <br />Lien Unit phofte: (804) 913-6050 • 7122o621D <br />As provided by sectian 632 t, 6322, and 6323 of the Internal Revenae <br />Code, we are �Iv1n� a notice that wc�s (inchrding interest and penalties) <br />have been assessed againisc the following�named taxpayer. We have made <br />a demand for payment of this Iiability, but it remains unpaid. Therefore, <br />there is a lien in favar of the united States at all praperty and right�t to <br />praperty.belonging #o th�s taxpayer for the amount of th�se taxes, and <br />addit�ona! penattie:, interest, and tosts titat may a�crue. <br />Name of Taxpayer W�LLIS SHOF AND BpOT INC <br />a Corporation <br />Residence 379 N WALNUT ST <br />GRAND 2SLAND, NE 6$801-4513 <br />�003/006 <br />e.i _ uee �� <br />2oioos2o4 <br />1MP�RTANT REI.F,ASE IN�ORMATION For each assessment listed below, <br />unless notice of the lien is refiled by the date given in column (e►, this notice shall, <br />on the day following suoh date, operate as a cert'rftcate af release as defined <br />in IRC 6325(a). <br />Tax Petiod Date of last Day for <br />Kind oF Tax Ending Ident�fying Number Asse�sment R�filipg <br />a b) c) (d (e) <br />9�41 03/31/2010 47-p8213S8 0�/0�/20�o a�/o�/aozo <br />Place of Filing <br />4651.46 <br />Register of Deeds <br />H�11 POBOX 1592 <br />Grand zsland, N� 68802-169 <br />Total �$ �651.46 <br />This na'tic�e was prapared and signed at <br />the �' day of OGtober <br />2010 <br />CHICAGO, IL <br />, an this, <br />Signature � Title <br />REVENIIE aFF�CER 24--1p-17�4 <br />for PATRICK J KELLO (3�8) 384-4850 , <br />(NOTE: Certificate of pfficer authorized by law to take acknowledgment is�not sssential ta the validity of Notice pf Federal Tax lien <br />Rev. Rul. 71-466, 1971 - 2 C.g, 409) <br />Pare 1- Kept By Recordldg Office Form 6b8(Y)(t) {Rev. 2-2004) <br />CAT. ND BD026X <br />llnpaid Balance <br />of Assessment <br />� <br />i <br />�! <br />WIL4IS SHDE pNp �OA7 ING A CpR <br />Ftisd: 11�03�2e1e 12:58 Pn <br />