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1, CCC-297 (08-18-04) 2011095'77 Page 2 of 2 IN WITNESS WHEREOF, the undersigned parti hereto have executed this instrument this (h) ��''= day og �� . e.E u.��. , G)� if a corporation: (k) Name of Corporate (11lortgagee) (Owner) * By (l) Duly Authorized Of�'icer (m) Title CORpORATE SEAL "Mortgagee" includes holder of any type of real estate lien. *Delete "Mortgagee" or "Owner." G RRYL MCAHREN (Owner) �� DARLENE A MCAHREN (Owner) (p) STATE OF � 4 -�oq-�-t[,oA. (c� COUNTY OF 1,q�� } Ss. ACKNOWLEDGMENT: On this (r) �� day of (s) ��-�E �"-'�a�- in the year (t) �t ( , before me, the undersigned, a Notary Public in and for said State, personally appeared (u)�ee�. t- 1�1n.�t+ra�1 `'� �E a personally known to me or proved to me on the basis of satisfactory evidence to be the individual(s) whose name(s) is �N'� � (are) subscribed to the within instrument and acknowledged to me that he/she executed the same in his/her/their capacity (ies), and that by his/her/their signature(s) on the instrument, the individual(s) or the person on behalf of which the individual(cl acted_ execute the inctniment. � �FNIERAL NOTARY - 5tate of Nepra�a SHELI.�I' K �HROmER My+ Comm. Exp. Oct 5, 20I�1 (SEAL) My commission expires (w) `` �.�„� � � � . Ib - �.-r (MM-DD-YYY ) The following statement is made rn accordance with the Prrvacy Act of 1974 (5 USC 552a) and the Paperwork Reduction Act of 1995, as amended. The authority for requesting the following informaUon is 7 CFR Part 1436 and the Commodity CredB Co�poration CharterAct, 5 USC 714 et. seq. The information wDl be used to determine ellglbairy (oi CCC Rnancing /or farm, storage a� dry'mg equipment Fumishing the requested information Is voluntary,• however, wdhout it CCC financing unda.r the program cannot be provided. Fadure to fumish the requested informa6bn wdl result In denlal of CCC Rnancing under this program. This Irrformation may be providea'to other agencies, IRS, Department of Justrce, or other State and Federal law enforcement agencles, and in response to a crourt magistrate or adminislrative VibunaL The provisions of criminal and clvfl (raud statutes, including 18 USC 286, 287, 371, 641, 651, 1001; 15 USC 714m; and 31 USC 3729, may be appBcable to the information provideol. According ro the Paperwork Reducdon Act of 1995, an agency may not conduct or sponsor, and a person is not required ro respond ro, a collec6on of informadon unless it displays a valld OMB conboi number: The valld OMB control number for this informad'on collectlon is 0560-0204. The dme requ�ed ro complete thrs iMormatlon colfecUon is esHmated to average 15 minutes perresponse, including ihe Ume Porrevlewing InsWctlons, searching existing data �urces, gadiering and malntaining the data needed, and crompletlng and reviewing the collectlon of informatlon. RE7URN THIS COMPLETED FORM TO YOUR COUNTYFSA OFFICE