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�0�20882� <br />Loan Number: 201124059 <br />WARNING TO HOMEOWNER <br />YOU ARE REQUIRED TO DO THE FOLLOWIl�TG: <br />1. COMPLETE AND RETURN THIS FORM TO THE PERSON WHO ASKED FOR IT WITHIN TEN <br />DAYS AFTER THE D?.TE OF TII� POSTMARK OF THE 1tEQUEST. <br />2. IF YOU DO NOT COMPLETE AND RETURN THIS FORM WITHIN TI� TEN DAY PERIOD, YOU <br />HAVE TO PAY TI� EXPENSES INCURRED IN GETTING TI-� INFORMATION. <br />3. IF YOU DO NOT LIVE AT TI� 5ITE OF THE IMPROVEMENT, YOU MUST POST A COPY OF <br />THIS FORM IN A CONSPICUOUS PLACE AT THAT SITE. <br />YOU ARE NOT REQUIRED TO BUT SHOULD DO THE FOLLOWING: <br />1. COMPLETE AND POST A COPY OF THIS FORM AT THE PLACE WHERE THE IMPROVEMENT <br />IS BEING MADE, EVEN IF YOU LIVE TI�RE. <br />.��0�� cs�, <br />Gerald P Carkoslfl . Borrower <br />This instrument was prepared by: <br />Exchange Bank <br />1204 Allen Drive, PO Boa 5793 <br />Grand Island, NEBRASKA 68802 <br />308-382-2900 <br />Ezchange Bank <br />1204 Allen Drive, PO Bog 5793 <br />Grand Island, NEBRASKA 68802 <br />STATE �OF NEBRASKA, Hall County ss: <br />" S�l <br />Carkosln Borrower <br />The fore oing instrument was acknowledged before me this _�� day of <br />r� � , , by Gerald P Carkoslu and Suzanne R Carkosla. <br />Witne s my hand a.nd notarial seal at /�?0�1��°nD�, G.a..d.T/�,d�in said County, the date <br />aforesaid. <br />My Commission Expires: r��� a��/� <br />� �� <br />o�. � � <br />IDS, Inc. <br />� - � <br />.: � � <br />Page 3 of 3 <br />