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DR <br />11a. ORGANIZATIONS NAME <br />11b. INDNIDUAL'S LAST NAME <br />FIRST NAME <br />MIDDLE NAME <br />SUFFIX <br />11c. MAILING ADDRESS <br />CITY <br />STATE <br />POSTAL CODE <br />COUNTRY <br />11d <br />SEE INSTRUCTION <br />ADM INFO RE <br />ORGANIZATION <br />DEBTOR <br />11e. TYPE OF ORGANIZATION <br />11f. JURISDICTION OF ORGANIZATION <br />11g. ORGANIZATIONAL ID A, if any <br />❑ NONE <br />NAME OF FIRST DEBTOR (la or 1b) ON RELATED FINANCING STATEMENT <br />9a. ORGANIZATION'S NAME <br />9b. INDIVIDUAL'S LAST NAME <br />ROMERO <br />MISCELLANEOUS <br />269221 -NE -557 <br />with: CC NE Hail County Register of Deeds, NE <br />FIRST NAME <br />ARAMEO <br />MIDDLE NAME,SUFFIX <br />FINANCING STATEMENT ADDENDUM <br />FOLLOW INSTRUCTIONS (front and back) CAREFULLY <br />9 . <br />OR <br />10. <br />38 <br />10656 PRIME ACCEPTAN <br />Fi <br />THE ABOVE SPACE IS FOR RUNG OFFICE USE ONLY <br />11. ADDITIONAL DEBTOR'S EXACT FULL LEGAL NAME - insert only oname (11a or 11 b) - do not abbreviate or combine names <br />12. ❑ ADDITIONAL SECURED PARTY'S I. <br />OR <br />12a. ORGANIZATION'S NAME <br />12b. INDIVIDUAL'S LAST NAME <br />12c. NAILING ADDRESS <br />13, This FINANCING STATEMENT covers ❑ timber to be cut or <br />collateral or is filed as a © fixture filing. <br />14. Description of real estate: <br />Description: LOT 5, BLOCK 5, EVAN'S ADDITION CITY <br />OF GRAND ISLAND, HALL COUNTY, NEBRASKA. AP; <br />400128446 <br />15. Name and address of a RECORD OWNER of above-described real estate <br />(if Debtor does not have a record interest): <br />ASSIGNOR S/P's NAME - insert only gmname (12a or 12b) <br />xtracted <br />FIRST NAME <br />CITY <br />16. Additional collateral description: <br />FILING OFFICE COPY - NATIONAL UCC FINANCING STATEMENT ADDENDUM (FORM UCC1Ad) (REV. 05/21/09) <br />MIDDLE NAME <br />STATE <br />POSTAL CODE <br />18. Check gON if applicable and check Qone box. <br />❑ Debtor is a TRANSMITTING UTILITY <br />El Filed in connection with a Manufactured-Home Transaction <br />❑ Filed in connection with a Public-Finance Transaction <br />201304156 <br />17. Check qtly if applicable and check gpkone box. <br />Debtor is a❑ Trust or ❑ Trustee acting with respect to property held in trust <br />SUFFIX <br />COUNTRY <br />Decedent's Estate <br />Prepared by CT Lien Solutions, P.O. Box 29071 <br />Glendale, CA 91209-9071 Tel (800) 331 -3282 <br />