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11 <br />INITIAL FINANCING STATEMENT FILE # (same as item 1a on Amendment form) <br />strument No. 200910103 <br />NAME OF PARTY AUTHORIZING THIS AMENDMENT (same as item 9 on Amendment form) <br />15a. ORGANIZATION'S NAME <br />Union Bank & Trust Company -Grand Island <br />15b. INDIVIDUALS LAST NAME <br />MISCELLANEOUS <br />FIRST NAME <br />MIDDLE NAME,SUFFIX <br />UCC FINANCING STATEMENT AMENDMENT ADDITIONAL PARTY <br />FOLLOW INSTRUCTIONS (front and back) CAREFULLY <br />14. <br />In <br />15. <br />OR <br />16. <br />17. ADDITIONAL DEBTORS EXACT FULL LEGAL NAME - insert only glLt name (17a or 17b) - do not abbreviate or combine names <br />17a. ORGANIZATIONS NAME <br />17b. INDIVIDUALS LAST NAME <br />Shriner <br />MAILING ADDRESS <br />50 N Webb Road <br />SEE INSTRUCTIONS ADD'L INFO RE 117e. TYPE OF ORGANIZATION <br />ORGANIZATION <br />DEBTOR 'Individual <br />FIRST NAME <br />Joyce <br />CITY <br />Grand Island <br />17f. JURISDICTION OF ORGANIZATION <br />MIDDLE NAME <br />A <br />STATE <br />NE <br />POSTAL CODE <br />68803 <br />17g. ORGANIZATIONAL 0 #, if any <br />OR <br />17c. <br />1 5 ' <br />18. ADDITIONAL DEBTOR'S EXACT FULL LEGAL NAME - insert only gOg name (18a or 18b) - do not abbreviate or combine names <br />18a. ORGANIZATIONS NAME <br />18b. INDIVIDUAL'S LAST NAME <br />MAILING ADDRESS <br />SEE INSTRUCTIONS <br />ADD'L INFO RE 118e. TYPE OF ORGANIZATION <br />ORGANIZATION <br />DEBTOR <br />FIRST NAME <br />CITY <br />18f. JURISDICTION OF ORGANIZATION <br />MIDDLE NAME <br />STATE <br />POSTAL CODE <br />18g. ORGANIZATIONAL ID #, if any <br />n <br />OR <br />18c. <br />18d. <br />19. ADDITIONAL DEBTOR'S EXACT FULL LEGAL NAME - insert only one name (19a or 19b) - do not abbreviate or combine names <br />19a. ORGANIZATION'S NAME <br />19b. INDIVIDUAL'S LAST NAME <br />MAILING ADDRESS <br />SEE INSTRUCTIONS <br />AMYL INFO RE 119e. TYPE OF ORGANIZATION <br />ORGANIZATION <br />DEBTOR <br />FIRST NAME <br />CITY <br />19f. JURISDICTION OF ORGANIZATION <br />MIDDLE NAME <br />STATE <br />POSTAL CODE <br />19g. ORGANIZATIONAL ID #, if any <br />OR <br />19c. <br />19d <br />20. ADDITIONAL SECURED PARTY'S NAME (or Name of TOTAL ASSIGNEE) - insert only gna name (20a or 20b) <br />OR <br />20c. <br />21. ADDITIONAL SECURED PARTY'S NAME (or Name of TOTAL ASSIGNEE) - insert only gge name (21a or 21b) <br />OR <br />21c. <br />201304426 <br />THE ABOVE SPACE IS FOR FILING OFFICE USE ONLY <br />SUFFIX <br />COUNTRY <br />USA <br />SUFFIX <br />COUNTRY <br />SUFFIX <br />COUNTRY <br />SUFFIX <br />COUNTRY <br />SUFFIX <br />COUNTRY <br />NONE <br />NONE <br />NONE <br />20a. ORGANIZATIONS NAME <br />20b. INDIVIDUALS LAST NAME <br />MAILING ADDRESS <br />FIRST NAME <br />CITY <br />MIDDLE NAME <br />STATE <br />POSTAL CODE <br />21a. ORGANIZATIONS NAME <br />21 b. INDIVIDUALS LAST NAME <br />MAILING ADDRESS <br />FIRST NAME <br />CITY <br />MIDDLE NAME <br />STATE <br />POSTAL CODE <br />International Association of Commercial Administrators (IACA) <br />FILING OFFICE COPY - UCC FINANCING STATEMENT AMENDMENT ADDITIONAL PARTY (FORM UCC3AP) (REV. 05/22/02) <br />