BANKRUPTCY COURT FOR THE SOUTHERN DISTRICT OF NEW YORK Fill in this information to identify the case (Select only one Debtor per claim form): Holdings Corporation ✘ Corporation Sears, Roebuck de Puerto MyGofer LLC Kmart.com LLC (18-23538) (18-23549) Rico, Inc. (18-23561) (18-23573) (18-23585) Sears, Roebuck and Co. MaxServ, Inc. SYW Relay LLC Sears Business Unit Sears Brands Management (18-23537) (18-23550) (18-23562) Corporation (18-23574) Corporation (18-23586) Kmart Holding Corporation Private Brands, Ltd. Wally Labs LLC Sears Holdings Publishing SHC Licensed Business (18-23539) (18-23551) (18-23563) Company, LLC (18-23575) LLC (18-23616) Kmart Operations LLC Sears Development Co. Big Beaver of Florida Kmart of Michigan, Inc. SHC Promotions LLC (18-23540) (18-23552) Development, LLC (18-23564) (18-23576) (18-23630) Sears Operations LLC Sears Holdings Management Builder Appliances, SHC Desert Springs, LLC SRe Holding Corporation (18-23541) Corporation (18-23553) Inc. (18-23565) (18-23577) (19-22301) ServiceLive, Inc. Sears Home & Business Florida Builder Appliances, Inc. SOE, Inc. (18-23542) Franchises, Inc. (18-23554) (18-23566) (18-23578) A&E Factory Service, LLC Sears Home Improvement KBL Holding Inc. StarWest, LLC (18-23543) Products, Inc. (18-23555) (18-23567) (18-23579) A&E Home Delivery, LLC Sears Insurance Services, KLC, Inc. STI Merchandising, Inc. (18-23544) L.L.C. (18-23556) (18-23568) (18-23580) A&E Lawn & Garden, LLC Sears Procurement Services, Sears Protection Company Troy Coolidge No. 13, (18-23545) Inc. (18-23557) (Florida), L.L.C. (18-23569) LLC (18-23581) A&E Signature Service, LLC Sears Protection Company Kmart of Washington LLC BlueLight.com, Inc. (18-23546) (18-23558) (18-23570) (18-23582) FBA Holdings Inc. Sears Protection Company Kmart Stores of LLC Sears Brands, L.L.C. (18-23547) (PR) Inc. (18-23559) (18-23571) (18-23583) Innovel Solutions, Inc. Sears Roebuck Acceptance Kmart Stores of Texas LLC Sears Buying Services, (18-23548) Corp. (18-23560) (18-23572) Inc. (18-23584)

Proof of Claim 04/16 Read the instructions before filling out this form. This form is for making a claim for payment in a bankruptcy case. Do not use this form to make a request for payment of an administrative expense, other than a claim entitled to administrative priority pursuant to 11 U.S.C. § 503(b)(9). Make such a request according to 11 U.S.C. § 503. Filers must leave out or redact information that is entitled to privacy on this form or on any attached documents. Attach redacted copies of any documents that support the claim, such as promissory notes, purchase orders, invoices, itemized statements of running accounts, contracts, judgments, mortgages, and security agreements. Do not send original documents; they may be destroyed after scanning. If the documents are not available, explain in an attachment. A person who files a fraudulent claim could be fined up to $500,000, imprisoned for up to 5 years, or both. 18 U.S.C. §§ 152, 157, and 3571. Fill in all the information about the claim as of the date the case was filed. That date is on the notice of bankruptcy (Form 309) that you received.

Part 1: Identify the Claim

1. Who is the current Arkansas Department of Finance and Administration creditor? Name of the current creditor (the person or entity to be paid for this claim)

Other names the creditor used with the debtor

2. Has this claim been ✔ No acquired from someone else?  Yes. From whom?

3. Where should notices Where should notices to the creditor be sent? Where should payments to the creditor be sent? (if and payments to the different) creditor be sent? Federal Rule of Bankruptcy Procedure (FRBP) 2002(g)

Contact phone (501) 682-7030 Contact phone (501) 682-7030 [email protected] [email protected] Contact email Contact email

4. Does this claim amend ✔ No one already filed?  Yes. Claim number on court claims registry (if known) Filed on MM / DD / YYYY

5. Do you know if anyone ✔ No else has filed a proof  Yes. Who made the earlier filing? of claim for this claim?

Claim Number: 9494 Proof of Claim page 1 Part 2: Give Information About the Claim as of the Date the Case Was Filed

6. Do you have any number  No you use to identify the ✔ Yes. Last 4 digits of the debtor’s account or any number you use to identify the debtor: 9 5 0 0 debtor?

7. How much is the claim? $ 38415.04 . Does this amount include interest or other charges?  No ✘ Yes. Attach statement itemizing interest, fees, expenses, or other charges required by Bankruptcy Rule 3001(c)(2)(A).

8. What is the basis of the Examples: Goods sold, money loaned, lease, services performed, personal injury or wrongful death, or credit card. claim? Attach redacted copies of any documents supporting the claim required by Bankruptcy Rule 3001(c). Limit disclosing information that is entitled to privacy, such as health care information.

9. Is all or part of the claim ✔ No secured?  Yes. The claim is secured by a lien on property. Nature of property:  Real estate. If the claim is secured by the debtor’s principal residence, file a Mortgage Proof of Claim Attachment (Official Form 410-A) with this Proof of Claim.  Motor vehicle  Other. Describe:

Basis for perfection: Attach redacted copies of documents, if any, that show evidence of perfection of a security interest (for example, a mortgage, lien, certificate of title, financing statement, or other document that shows the lien has been filed or recorded.)

Value of property: $

Amount of the claim that is secured: $

Amount of the claim that is unsecured: $ 38415.04 (The sum of the secured and unsecured amounts should match the amount in line 7.)

Amount necessary to cure any default as of the date of the petition: $

Annual Interest Rate (when case was filed) %  Fixed  Variable

10. Is this claim based on a ✔ No lease?  Yes. Amount necessary to cure any default as of the date of the petition. $

11. Is this claim subject to a  No right of setoff? ✔ Yes. Identify the property: Eligible tax refunds

Modified Form 410 Proof of Claim page 2 12. Is all or part of the claim  No entitled to priority under ✔ 11 U.S.C. § 507(a)?  Yes. Check one: Amount entitled to priority A claim may be partly  Domestic support obligations (including alimony and child support) under priority and partly 11 U.S.C. § 507(a)(1)(A) or (a)(1)(B). $ nonpriority. For example, in some categories, the  Up to $2,850* of deposits toward purchase, lease, or rental of property or services for law limits the amount personal, family, or household use. 11 U.S.C. § 507(a)(7). $ entitled to priority.  Wages, salaries, or commissions (up to $12,850*) earned within 180 days before the bankruptcy petition is filed or the debtor’s business ends, whichever is earlier. $ 11 U.S.C. § 507(a)(4). ✔ Taxes or penalties owed to governmental units. 11 U.S.C. § 507(a)(8). $ 38415.04

 Contributions to an employee benefit plan. 11 U.S.C. § 507(a)(5). $

 Other. Specify subsection of 11 U.S.C. § 507(a)( ) that applies. $

* Amounts are subject to adjustment on 4/01/19 and every 3 years after that for cases begun on or after the date of adjustment.

13. Is all or part of the  No claim entitled to administrative priority  Yes. Indicate the amount of your claim arising from the value of any goods received $ ______pursuant to by the Debtor within 20 days before the date of commencement of the above case, in 11 U.S.C. § 503(b)(9)? which the goods have been sold to the Debtor in the ordinary course of such Debtor’s business. Attach documentation supporting such claim.

Part 3: Sign Below

The person completing Check the appropriate box: this proof of claim must sign and date it.  I am the creditor. FRBP 9011(b). ✔ I am the creditor’s attorney or authorized agent. If you file this claim  I am the trustee, or the debtor, or their authorized agent. Bankruptcy Rule 3004. electronically, FRBP  I am a guarantor, surety, endorser, or other codebtor. Bankruptcy Rule 3005. 5005(a)(2) authorizes courts to establish local rules I understand that an authorized signature on this Proof of Claim serves as an acknowledgment that when calculating the specifying what a signature amount of the claim, the creditor gave the debtor credit for any payments received toward the debt. is. I have examined the information in this Proof of Claim and have a reasonable belief that the information is true A person who files a and correct. fraudulent claim could be fined up to $500,000, I declare under penalty of perjury that the foregoing is true and correct. imprisoned for up to 5 Signature: Michelle L. Baker years, or both. Michelle L. Baker (Mar 8, 2019) 18 U.S.C. §§ 152, 157, and 3571. Email: [email protected]

Signature Print the name of the person who is completing and signing this claim: Name of the person who is completing and signing this claim:

Name Michelle L. Baker First name Middle name Last name

Title Managing Attorney

Company Arkansas Department of Finance and Administration Identify the corporate servicer as the company if the authorized agent is a servicer.

Address P.O. Box 1272 Number Street Little Rock AR 72202 City State ZIP Code

Contact phone (501) 682-7030 Email (501) 682-7030

Modified Form 410 Proof of Claim page 3 Attach Supporting Documentation (limited to a single PDF attachment that is less than 5 megabytes in size and under 100 pages):

❐✘ I have supporting documentation. ❐I do not have supporting documentation. (attach below)

Attachment

PLEASE REVIEW YOUR PROOF OF CLAIM AND SUPPORTING DOCUMENTS AND REDACT ACCORDINGLY PRIOR TO UPLOADING THEM. PROOFS OF CLAIM AND ATTACHMENTS ARE PUBLIC DOCUMENTS THAT WILL BE AVAILABLE FOR ANYONE TO VIEW ONLINE. IMPORTANT NOTE REGARDING REDACTING YOUR PROOF OF CLAIM AND SUPPORTING DOCUMENTATION When you submit a proof of claim and any supporting documentation you must show only the last four digits of any social-security, individual’s tax-identification, or financial-account number, only the initials of a minor’s name, and only the year of any person’s date of birth. If the claim is based on the delivery of health care goods or services, limit the disclosure of the goods or services so as to avoid embarrassment or the disclosure of confidential health care information. A document has been redacted when the person filing it has masked, edited out, or otherwise deleted, certain information. The responsibility for redacting personal data identifiers (as defined in Federal Rule of Bankruptcy Procedure 9037) rests solely with the party submitting the documentation and their counsel. Prime Clerk and the Clerk of the Court will not review any document for redaction or compliance with this Rule and you hereby release and agree to hold harmless Prime Clerk and the Clerk of the Court from the disclosure of any personal data identifiers included in your submission. In the event Prime Clerk or the Clerk of the Court discover that personal identifier data or information concerning a minor individual has been included in a pleading, Prime Clerk and the Clerk of the Court are authorized, in their sole discretion, to redact all such information from the text of the filing and make an entry indicating the correction. Modified Form 410 Instructions for Proof of Claim United States Bankruptcy Court 12/15

These instructions and definitions generally explain the law. In certain circumstances, such as bankruptcy cases that debtors do not file voluntarily, exceptions to these general rules may apply. You should consider obtaining the advice of an attorney, especially if you are unfamiliar with the bankruptcy process and privacy regulations.

A person who files a fraudulent claim could be fined up to $500,000, imprisoned for up to 5 years, or both. 18 U.S.C. §§ 152, 157 and 3571.

How to fill out this form  A Proof of Claim form and any attached documents must show only the last 4 digits of any social security  Fill in all of the information about the claim as of the number, individual’s tax identification number, or date the case was filed. financial account number, and only the year of any person’s date of birth. See Bankruptcy Rule 9037.  Fill in the caption at the top of the form.  For a minor child, fill in only the child’s initials and the full name and address of the child’s parent or  If the claim has been acquired from someone else, guardian. A.B., a minor child John then state the identity of the last party who owned the For example, write ( claim or was the holder of the claim and who transferred Doe, parent, 123 Main St., City, State). See Bankruptcy it to you before the initial claim was filed. Rule 9037.

 Attach any supporting documents to this form. Attach redacted copies of any documents that show that the Confirmation that the claim has been filed debt exists, a lien secures the debt, or both. (See the definition of redaction on the next page.) To receive confirmation that the claim has been filed, either enclose a stamped self-addressed envelope and a copy of this Also attach redacted copies of any documents that show form. You may view a list of filed claims in this case by visiting perfection of any security interest or any assignments or the Claims and Noticing Agent's website at transfers of the debt. In addition to the documents, a http://restructuring.primeclerk.com/sears. summary may be added. Federal Rule of Bankruptcy Procedure (called “Bankruptcy Rule”) 3001(c) and (d). Understand the terms used in this form  Do not attach original documents because Administrative expense: Generally, an expense that arises attachments may be destroyed after scanning. after a bankruptcy case is filed in connection with operating, liquidating, or distributing the bankruptcy estate.  If the claim is based on delivering health care goods 11 U.S.C. § 503. or services, do not disclose confidential health care information. Leave out or redact confidential Claim: A creditor’s right to receive payment for a debt that information both in the claim and in the attached documents. the debtor owed on the date the debtor filed for bankruptcy. 11 U.S.C. §101 (5). A claim may be secured or unsecured. Claim Pursuant to 11 U.S.C. §503(b)(9): A claim arising Secured claim under 11 U.S.C. §506(a): A claim backed by from the value of any goods received by the Debtor within a lien on particular property of the debtor. A claim is secured 20 days before the date of commencement of the above case, to the extent that a creditor has the right to be paid from the in which the goods have been sold to the Debtor in the property before other creditors are paid. The amount of a ordinary course of the Debtor's business. Attach secured claim usually cannot be more than the value of the documentation supporting such claim. particular property hon which t e creditor has a lien. Any amount owed to a creditor that is more than the value of the Creditor: A person, corporation, or other entity to whom a property normally may be an unsecured claim. But exceptions debtor owes a debt that was incurred on or before the date the exist; for example, see 11 U.S.C. § 1322(b) and the final debtor filed for bankruptcy. 11 U.S.C. §101 (10). sentence of 1325(a). Examples of liens on property include a mortgage on real Debtor: A person, corporation, or other entity who is in estate or a security interest in a car. A lien may be voluntarily bankruptcy. Use the debtor’s name and case number as shown granted by a debtor or may be obtained through a court in the bankruptcy notice you received. 11 U.S.C. § 101 (13). proceeding. In some states, a court judgment may be a lien.

Evidence of perfection: Evidence of perfection of a security Setoff: Occurs when a creditor pays itself with money interest may include documents showing that a security belonging to the debtor that it is holding,y or b canceling a interest has been filed or recorded, such as a mortgage, lien, debt it owes to the debtor. certificate of title, or financing statement. Unsecured claim: A claim that does not meet the Information that is entitled to privacy: A Proof of Claim requirements of a secured claim. A claim may be unsecured in form and any attached documents must show only the last 4 part to the extent that the amount of the claim is more than the digits of any social security number, an individual’s tax value of the property on which a creditor has a lien. identification number, or a financial account number, only the initials of a minor’s name, and only the year of any person’s date of birth. If a claim is based on delivering health care Offers to purchase a claim goods or services, limit the disclosure of the goods or services Certain entities purchase claims for an amount that is less than to avoid embarrassment or disclosure of confidential health the face value of the claims. These entities may contact care information. You may later be required to give more creditors offering to purchase their claims. Some written information if the trustee or someone else in interest objects to communications from these entities may easily be confused the claim. with official court documentation or communications from the debtor. These entities do not represent the bankruptcy court, Priority claim: A claim within a category of unsecured the bankruptcy trustee, or the debtor. A creditor has no claims that is entitled to priority under 11 U.S.C. §507(a). obligation to sell its claim. However, if a creditor decides to These claims are paid from the available money or sell its claim, any transfer of that claim is subject to property in a bankruptcy case before other unsecured Bankruptcy Rule 3001(e), any provisions of t he Bankruptcy claims are paid. Common priority unsecured claims Code (11 U.S.C. § 101 et seq.) that apply, and any orders of include alimony, child support, taxes, and certain unpaid the bankruptcy court that apply. wages.

Proof of claim: A form that shows the amount of debt the Please send completed Proof(s) of Claim to: debtor owed to a creditor on the date of the bankruptcy filing. Sears Holdings Corporation Claims Processing Center The form must be filed in the district where the case is c/o Prime Clerk LLC pending. 850 3rd Avenue, Suite 412 Brooklyn, NY 11232 Redaction of information: Masking, editing out, or deleting certain information to protect privacy. Filers must redact or leave out information entitled to privacy on the Proof of Claim form and any attached documents. Do not file these instructions with your form

STATE OF ARKANSAS DEPARTMENT OF FINANCE AND ADMINISTRATION YOUR RIGHTS AS A TAXPAYER

You have the r ght to a fu exp anat on of a act ons by any emp oyee of the D rector of the Department of F nance and Adm n strat on both dur ng an aud t and dur ng co ect on act v t es. • A tax nformat on conta ned n the records and f es of the D rector of the Department of F nance and Adm n strat on (here nafter "D rector") perta n ng to you or your bus ness s conf dent a subject to except ons n Ark. Code Ann. § 26 18 303. • You may represent yourse f n any proceed ng or nterv ew before the D rector or you may be represented by anyone whom you author ze n wr t ng to be your representat ve. • You have the r ght to consu t w th a awyer, accountant, or other representat ve at any t me dur ng an nterv ew w th an emp oyee of the D rector. The D rector sha suspend the nterv ew to a ow you to consu t w th your representat ve. • You may record any nterv ew w th the D rector or h s or her emp oyee at your own expense. You shou d et the D rector or h s or her emp oyee know n advance of your ntent on to record the nterv ew. The D rector may kew se record an nterv ew, and a copy may be obta ned w th n a reasonab e t me at your expense. • You may request an n strat ve rev ew (f e a protest) of any proposed assessment of tax. You must request th s rev ew n wr t ng w th n 60 days of your rece pt of a Not ce of Proposed Assessment. The adm n strat ve rev ew may be based on an n person hear ng, a te ephone hear ng, or cons derat on of wr tten documents. If you do not request an adm n strat ve hear ng, you may st pursue your jud c a remed es by f ng an act on n the c rcu t court. • If you rece ve an unfavorab e dec s on from your adm n strat ve rev ew, then you may request a rev ew of the dec s on by the D rector. Th s request must be n wr t ng and must be rece ved by the D rector w th n 20 days of the ma ng of the hear ng dec s on. If you rece ve an unfavorab e dec s on from the D rector on any ssue, you may pursue jud c a remed es as d scussed be ow. • After the ssuance of the Not ce of F na Assessment or the f na determ nat on of the hear ng off cer or D rector, you may appea the tax assessment to c rcu t court, regard ess of whether you protested the assessment and requested an adm n strat ve rev ew. To pursue your appea of a tax assessment to c rcu t court you must do one of the fo ow ng: (1) F e su t w th n 180 days of the date of the Not ce of F na Assessment or f na determ nat on of the hear ng off cer or D rector f the taxpayer does not make any payment of the tax, pena ty, or nterest due; or (2) Pay the ent re amount of tax due w th n one year of the date of the Not ce of F na Assessment or f na determ nat on of the hear ng off cer or D rector and f e su t w th n one year of the date of payment; or (3) F e su t w th n one year of the date of the f na determ nat on of the hear ng off cer or D rector to recover assessed tax, pena ty, and nterest pa d pr or to the t me for ssuance of the Not ce of F na Assessment. • A taxpayer may f e an amended return or a ver f ed c a m for cred t or refund of an overpayment of any state tax w th n three years from the date the return was f ed or two years from the date the tax was pa d, wh chever s ater. Any amended return or c a m for refund shou d be f ed w th the off ce of the Revenue D v s on wh ch adm n sters the type of tax n quest on. The ab ty to f e an amended return s not ava ab e to a taxpayer whose ab ty was determ ned as a resu t of an aud t by the Department. • If the D rector d sa ows the refund c a m e ther n who e or n part, the D rector w ssue a Not ce of C a m Den a . You may request an adm n strat ve rev ew (protest) of the Not ce of C a m Den a . Th s request must be made w th n 60 days of your rece pt of the Not ce of C a m Den a . If you rece ve an unfavorab e dec s on from your adm n strat ve rev ew, you may request a rev ew of the dec s on by the D rector. Th s request must be made n wr t ng w th n 20 days of the ma ng of the hear ng dec s on. • Fo ow ng an adm n strat ve hear ng and correspond ng rev ew, the taxpayer may seek jud c a re ef from the Not ce of C a m Den a by appea ng the dec s on to c rcu t court. Jud c a rev ew s ava ab e whether or not you requested an adm n strat ve rev ew. To pursue your appea to c rcu t court, you must f e su t w th n one year of the date of the ma ng of the Not ce of C a m Den a , the f na determ nat on of the hear ng off cer, or rev s on dec s on of the D rector, wh chever s ater. If the D rector fa s to ssue a wr tten dec s on n response to the refund c a m w th n s x months of the date a c a m for refund s f ed, the taxpayer may then f e su t to recover the amount c a med. • Any taxpayer who w shes to f e a request for adm n strat ve rev ew (protest) of a proposed assessment or a comp a nt regard ng any act v ty concern ng the adm n strat on or co ect on of any state tax by the Revenue D v s on shou d make the protest or comp a nt n wr t ng to: ASSISTANT​ COMMISSIONER FOR POLICY AND LEGAL Mailing Address: LEDBETTER BUILDING, ROOM 2440, P.O. BOX 1272 LITTLE ROCK, AR 72203-1272 Overnight Mailing Address: LEDBETTER BUILDING, ROOM 2440, 1816 W. 7TH ST. LITTLE ROCK, AR 72201 Email Address: [email protected] Fax: (501) 683-1161 • In adm n ster ng the state tax aws, the D rector s author zed by aw to make an exam nat on or nvest gat on of the bus ness, books, and records of the taxpayer. If the D rector determ nes that an add t ona amount of tax s due, then a Not ce of Proposed Assessment sha be ssued to the taxpayer. The taxpayer may seek re ef from the Not ce of Proposed Assessment as out ned above. If the taxpayer fa s to preserve and ma nta n records su tab e to determ ne the amount of tax due or to prove accuracy of any return, the D rector may make an est mated assessment based upon the best nformat on ava ab e as to the amount of tax due by the taxpayer. • The D rector may ssue a jeopardy assessment aga nst any taxpayer (1) whose tax ab ty exceeds any bond on f e ndemn fy ng the state for the payment of a state tax, (2) who ntends to eave the State, remove h s or her property, or concea h mse f or herse f or h s or her property, (3) who ntends to d scont nue h s or her bus ness w thout mak ng adequate prov s ons for payment of state taxes or, (4) who does any other act tend ng to prejud ce or jeopard ze the D rector's ab ty to compute, assess, or co ect any state tax. Any taxpayer seek ng re ef from a jeopardy assessment must request an adm n strat ve hear ng w th n f ve days from the rece pt of the Not ce of Proposed Assessment. • When co ect ng any state tax due from a taxpayer, the D rector s author zed to f e a Cert f cate of Indebtedness (state tax en) w th the c rcu t c erk of any county of th s state cert fy ng that the person named there n s ndebted to the state for the amount of tax due as estab shed by the D rector. The Cert f cate of Indebtedness sha have the same force and effect as the entry of a judgment rendered by a c rcu t court and sha const tute a en upon the t t e of any rea and persona property of the taxpayer n the county where the Cert f cate of Indebtedness s recorded. • After the f ng of the Cert f cate of Indebtedness, the D rector may take a steps author zed by aw for the co ect on of the tax, nc ud ng the ssuance of a wr t of execut on, garn shment, and cance at on of any state tax perm ts or reg strat ons.

Any court costs or sher ff's fees wh ch resu t from the D rector's attempt to co ect de nquent taxes sha be co ected from the taxpayer n add t on to the tax, nterest, and pena t es nc uded n the Cert f cate of Indebtedness.

Revised 02/2016 0 L0278854800 btL00

STATE OF ARKANSAS DEPARTMENT OF FINANCE AND ADMINISTRATION

Protest Form

March 6, 2019 Letter ID: L0278854800 K MART Account ID: 9302-SLS 3333 BEVERLY RD DEPT 768TAX Audit ID: A181692416 HOFFMAN ESTATES IL 60179-0001 Audit From: October 1, 2013 Audit To: September 30, 2016

K MART CORPORATION PROTEST OF ASSESSMENT: Total Assessed: $38,415.04

Complete the information below concerning your protest and return to the address listed below. Your protest must be delivered or postmarked by May 05, 2019.

I, , received a proposed assessment as described above of Arkansas tax, interest and penalty pending against me.

I protest the proposed assessment and request: (Check 1, 2 or 3 below)

1. Consideration of written documents submitted: (a) documents included with the protest (complete statement below), or (b) documents to be submitted according to a briefing schedule set by the Hearing Board.

2. An administrative hearing to be held at: (circle one)

Arkadelphia Fort Smith Jonesboro Little Rock Pine Bluff Bentonville

I agree to appear on the date and at the time and place set for such hearing as provided by law.

3. Request for administrative hearing by telephone. This number will be called for the hearing unless you write/fax/email to change number in advance of hearing. Enter phone number here:

I disagree with the proposed assessment for the following reasons (add additional page if necessary):

Sign and return protest to: Signature of Taxpayer/Business Official Assistant Commissioner Policy and Legal P.O. Box 1272 - Room 2440 Little Rock, AR 72203-1272

Print Name Fax : (501) 683-1161 Email : [email protected]

Date Phone

Basis for Adjustment

K MART CORPORATION Account ID: 9302-SLS Audit ID: A181692416 Audit From: October 1, 2013 Audit To: September 30, 2016

Use 0015 STATE CONSUMER USE TAX Unreported Taxable Purchases $342,351.38 $342,351.38 1600 CRAIGHEAD COUNTY Unreported Taxable Purchases $67,488.40 $67,488.40 1611 JONESBORO Unreported Taxable Purchases $67,488.40 $67,488.40 4300 LONOKE COUNTY Unreported Taxable Purchases $64,020.50 $64,020.50 5800 POPE COUNTY Unreported Taxable Purchases $25,046.90 $25,046.90 5801 RUSSELLVILLE Unreported Taxable Purchases $25,046.90 $25,046.90 6000 PULASKI COUNTY Unreported Taxable Purchases $47,751.04 $47,751.04 6005 LITTLE ROCK Unreported Taxable Purchases $47,751.04 $47,751.04 7200 WASHINGTON COUNTY Unreported Taxable Purchases $45,325.78 $45,325.78 7210 SPRINGDALE Unreported Taxable Purchases $45,325.78 $45,325.78

Interest at the rate of 10% per annum is calculated in accordance with Ark. Code Ann. § 26-18-508. Electronic Proof of Claim Final Audit Report 2019-03-08

Created: 2019-03-08

By: Sears Claims ([email protected])

Status: Signed

Transaction ID: CBJCHBCAABAAc7ACy6yCuNqj4aHTq-dtJ82qboAKRC04

"Electronic Proof of Claim" History

Widget created by Sears Claims ([email protected]) 2019-03-08 - 6:43:43 PM GMT

Michelle L. Baker ([email protected]) uploaded the following supporting documents: Attachment

2019-03-08 - 6:51:05 PM GMT

Widget filled in by Michelle L. Baker ([email protected]) 2019-03-08 - 6:51:05 PM GMT- IP address: 150.208.129.198

(User email address provided through API User-Agent: Mozilla/5.0 (Windows NT 10.0; Win64; x64) AppleWebKit/537.36 (KHTML, like Gecko) Chrome/63.0.3239.132 Safari/537.36) 2019-03-08 - 6:51:08 PM GMT- IP address: 150.208.129.198

Signed document emailed to Michelle L. Baker ([email protected]) and Sears Claims ([email protected]) 2019-03-08 - 6:51:08 PM GMT