Case 1:07-cv-00739-ECH
Document 15-2
Filed 07/17/2008
Page 1 of 6
EXHIBIT 1
Case 1:07-cv-00739-ECH
Document 15-2
Filed 07/17/2008
Page 2 of 6
United States
of America
Department of the Treasury
Internal Revenue Service
Date: Oct. 30, 2007
CERTIFICATE OF OFFICIAL RECORD
I certify that the annexed: is a true Form 4340, Certificate of Assessments, Payments and Other Specified Matters for Intersport Fashions West Inc., EIN: 95-3425725, for u.s. Corporationl Income Tax Return (Form 1120), for the tax period ending September 30,2001, consisting of four
pages
IN WITNESS WHEREOF, I have hereunto set my hand, and caused the seal of this offce to be affixed, on the day and year first above written.
By direction of the Secretary of the Treasury:
( , \ " i . ( .-i \1 O(
Christine Stromberg /
SW Delegation Order 198
~. . 0 'i,- \,' ")1 U ,,'\- À \ ~:,Iì \L -1'--""
Supervisor Accounting Technician . Ogden W &1 Submission Processing
Catalog Number 19002E
Form 2866 (Rev. 09-1997)
Case 1:07-cv-00739-ECH Document 15-2 Filed 07/17/2008 Page 3 of 6 CERTIFICATE OF ASSESSMENTS, PAYMENTS, AND OTHER SPECIFIED MATTERS
INTERSPORT FASHIONS WEST INC
E IN/SSN: 95- 3425725
TYPE OF TAX: U. S. CORPORATION INCOME TAX RETURN
FORM: 1120 TAX PERIOD: SEPT 2001
DATE
EXPLANATION OF TRANSACTION
ASSESSMENT, OTHER DEBITS (REVERSAL)
PAYMENT,
ASSESSMENT
CREDIT (REVERSAL)
DATE (23C, RAC 006 )
RETURN PREPARER TIN:
564374519
NET TAXABLE INCOME
1,919,102.00
891,478.00 255,000.00 420,000.00
07-08-2002
05-24-2002 RETURN FILED
29310- 159-57733-2 200226
01-16-2001 ESTIMATED TAX/FEDERAL TAX DEPOSIT 03-20-2001 ESTIMATED TAX/FEDERAL TAX DEPOSIT
01-15-2001 OVERPAID CREDIT FROM PRIOR TAX PERIOD
12-17-2001 INITIAL INSTALLMENT
PAYMENT
30,920.97
200,000.00
02-04-2002 EXTENSION OF TIME TO FILE
EXT. DATE 06-15-2002
01-15-2002 OVERPAYMENT CREDIT ELECT TRANSFERRED TO NEXT TAX PERIOD
07-08-2002 INTEREST DUE TAXPAYER
07-08-2002 REFUND
(13,332.00)
21.29
(1,132.26)
565,231.00o . 00
PAGE
1
08-02-2004 PRIOR TAX ABATED TENTATIVE CARRYBACK CLAIM
29354- 596- 9 1 3 16-4
ADDITIONAL TAX ASSESSED 29354-596-91316-4 20042908
08-02-2004
FORM 4340 (REV. 01-2002)
Case 1:07-cv-00739-ECH
Document 15-2
Filed 07/17/2008
Page 4 of 6
CERTIFICATE OF ASSESSMENTS, PAYMENTS, AND OTHER SPECIFIED MATTERS
INTERSPORT FASHIONS WEST INC
E IN/SSN: 95- 3425725
TYPE OF TAX: U. S. CORPORATION INCOME TAX RETURN
FORM: 1120 TAX PERIOD: SEPT 2001
DATE
EXPLANATION OF TRANSACTION
ASSESSMENT, OTHER DEBITS (REVERSAi)
PA YMENT ,
ASSESSMENT
CREDIT (REVERSAL)
DATE (23C, RAC 006 )
08-02-2004 REFUND
(565,231.00)
02-04-2005 ASSESSMENT STATUTE EXPIR DATE EXTEND TO 05-24-2005 05-03-2005 ASSESSMENT STATUTE EXPIR DATE EXTEND TO 12-31-2005
ADDITIONAL TAX ASSESSED BY EXAMINATION AGREED AUDIT DEFICIENCY PRIOR TO 30 OR 60 DAY
LETTER
o .00
01-30-2006
29347-764-00016-5 20060308
QU ICK ASSESSMENT
29351 - 363- 13002-5 20062208
QU ICK ASSESSMENT
29351- 363- 13002- 5
82,060.00
12,592.00
12-29-2005
12-29-2005
08
07-08-2002 INTEREST CORRECTION
RESTRICTED INTEREST ASSESSED
(21.29)
7,869.92
PAGE
12-29-2005
20062208
FORM 4340 (REV. 01-2002)
2
Case 1:07-cv-00739-ECH Document 15-2 Filed 07/17/2008 Page 5 of 6 CERTIFICATE OF ASSESSMENTS, PAYMENTS, AND OTHER SPECIFIED MATTERS
INTERSPORT FASH IONS WEST INC
E IN/SSN: 95- 3425725
TYPE OF TAX: U. S. CORPORATION I NCOME TAX RETURN
FORM: 1120 TAX PERIOD: SEPT 2001
DATE
EXPLANATION OF TRANSACTION
ASSESSMENT, OTHER DEBITS (REVERSAL)
PAYMENT,
ASSESSMENT
CREDIT (REVERSAL)
DATE (23C, RAC 006 )
08-28-2006 MODULE IN FEDERAL PAYMENT LEVY PROGRAM
ADDITIONAL TAX ASSESSED BY EXAMINATION AUDIT, CLOSED TO APPEALS PRIOR TO 90 DAY LETTER
10-13-2006 RECEIVED POA/TIA
ADDITIONAL TAX ASSESSED BY EXAMINATION
0.00
09-11-2006
29347-636 -1 0 023-6 20063508
0.00
04- 16-2007
AUDIT REVIEW ASED 20070719
29347-486-79000-7
RENUMBERED RETURN
20071408
04-16-2007
29347-486 -790 0 0-7
PENAL TY
FAILURE TO PAY TAX
16,090.84
09-10-2007
20073508
12-29-2005 Statutory Notice of Balance Due 06- 12-2006 Stat ut ory Notice of Intent to Levy 09- 10-2007 Statutory Notice of Ba lance Due
FORM 4340
(REV.
01-2002)
PAGE
3
Case 1:07-cv-00739-ECH
Document 15-2
Filed 07/17/2008
Page 6 of 6
CERTIFICATE OF ASSESSMENTS, PAYMENTS, AND OTHER SPECIFIED MATTERS
INTERSPORT FASHIONS WEST INC
E IN/SSN: 95- 3425725
TYPE OF TAX: U. S. CORPORATION INCOME TAX RETURN
FORM: 1120 TAX PERIOD: SEPT 2001
BALANCE
118,634.05
I CERTIFY THAT THE FOREGOING TRANSCRIPT OF THE TAXPAYER NAMED ABOVE IN RESPECT TO THE TAXES SPECIFIED IS A TRUE AND COMPLETE TRANSCRIPT FOR THE PERIOD STATED, AND ALL ASSESSMENTS, ABATEMENTS, CREDITS, REFUNDS, AND ADVANCE OR UNIDENTIFIED PAYMENTS, AND THE ASSESSED BALANCE RELATING THERETO, AS DISCLOSED BY THE RECORDS OF THIS OFFICE AS OF THE ACCOUNT STATUS DATE ARE SHOWN THEREIN. I FURTHER CERTIFY THAT THE OTHER SPECIFIED MATTERS SET FORTH IN THIS TRANSCRIPT APPEAR IN THE OFF ICIAL RECORDS OF THE INTERNAL REVENUE SERVICE.
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - ~,- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
SIGNATURE OF CERTIFYING OFFICERQ\ \\~\ìC '&L\y\\;iY...~
PRINT NAME: Christine Stromberg d )
TITLE: Supervisor Accounting Technician, Ogden W&I Submission Processing
DELEGATION ORDER: SW Delegation Order 198
LOCATION: INTERNAL REVENUE SERVICE
ACCOUNT STATUS DATE 10/30/2007
FORM 4340 (REV. 01-2002)
PAGE
4