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. • <br />, ', <br />UCC FINANCING STATEMENT ADDENDUM 2 0�. 2 017 2� <br />FOLLOW INSTRUCTIONS (front and back) CAREFULLY <br />9. NAME OF FIRST DEBTOR (1a or 1b) ON RELATED FINANCING STATEMENT <br />9a. ORGANI7J\TION'S NAME <br />OR <br />9b. INDIVIDUAL'S LAST NAME FIRST NAME MIDDLE NAME,SUFFIX <br />FLORES CINDY S. <br />10. MISCELLANEOUS: <br />� THE ABpVE'SPACE IS FOR FILING OFFICE USE ONLY <br />11. ADDITIONAL �ESTOR'S EXACT FULL LEGAL NAME - Insert only Qng name (11a or 11b) - do not abbrev�ate or combino names <br />tta.ORG�NI7ATION'S NAME <br />OR � �b. INDIVIDUAL'S LAS� NAME FIRST NAME MIDDLE N�ME SUFi'IX <br />ttc. MAILING ADDRESS CI7Y STA7E POSTAL CODE C�?UNTRv <br />I 1SA <br />11d. SEE INSTRUC770NS ADD'L INFO RE 11e. NPE OF ORGANVATION 11f. JURISDICTION OF ORGANIZl�TION 11g. ORGANIZATIONAL ID #, if any <br />ORGANI7ATION <br />DEBTOR <br />12. ADDITIONAL StGUKtU PAK I Y'S � ASSIGNOR S/P'S NAME - insert only gp� namo (12a or 12b) _ <br />12a. ORGANIZATION'S NAME <br />OR 1zb. INpIVIDUAI'S IAST NAME FIRST NAME MIDDLE N�ME SJF� IX <br />13. This FINANCING STATEMENT coversu limber to be cut or I I as-extracled 16. Addi�onel collateral description: <br />u <br />colleleral, or is flled as a� fixture filing. <br />�a. oos��� or �e�� as�a��: furnish and install garage door per the work order dated <br />01/18/2012 in the amount of $2,656.73. <br />_ 1020 w 12th st <br />grand island, NE 68801 <br />15. Name and eddress oi a RECORD UWNER qf ebove-described rael estate <br />('rf Debtor doea not have a rocord Interest): <br />17. Check .q�y it applicabte and check ptil)( one box. <br />Deblor IS a Trusl or lrus�ee acling witn respect to property held in trust or DacednnCs Estate <br />18. Check g,p�y if applicable and chock g�y one 6oz <br />8 Deblor is a TRANSMITTING UTILITY <br />Filad in connection with a Menuteciured-Home �iransection <br />Filed In connection wflh a Publio-Finance Trensaction <br />Intemational Association of Commercial Administrators (IACA) <br />FILING OFFICE COPY — UCC FINl�NCING STATEMENT ADDFNDUM (FORM UCC1Ad) (REV OS/21/09) <br />