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WARNING TO HOMEOWNER <br />YOU ARE REQUIRED TO DO THE FOLLOWING: <br />1. COMPLETE AND RETURN THIS FORM TO THE PERSON WHO ASKED FOR IT WITHIN TEN <br />DAYS AFTER THE DATE OF THE POSTMARK OF THE REQUEST. <br />2. IF YOU DO NOT COMPLETE AND RETURN THIS FORM WITHIN THE TEN DAY PERIOD, YOU <br />HAVE TO PAY THE EXPENSES INCURRED IN GETTING THE INFORMATION. <br />3. IF YOU DO NOT LIVE AT THE SITE 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 THERE. <br />This instrument was prepared by: <br />Exchange Bank <br />1204 Allen Drive, PO Box 5793 <br />Grand Island, NEBRASKA 68802 <br />308 - 382 -2900 <br />Return To: <br />Exchange Bank <br />1204 Allen Drive, PO Box 5793 <br />Grand Island, NEBRASKA 68802 <br />STATE OF NEBRASKA, Hall <br />The regoing instrument <br />of 007.1"*i <br />Witness my hand and notarial <br />aforesaid. <br />My Commission Expires: April 7, 2016 <br />IDS, Inc. <br />GENERAL NOTARY - She at Nebraska <br />DANIEL ROTH <br />My Comm. bp. Apn17, 2016 <br />County ss: <br />Page 2 of 2 <br />Notary Public Daniel Roth <br />201309501 <br />Loan Number: 201125692 <br />was acknowledged before me this 3� day <br />� �/ Joseph P Brown and Stefani J Brown. G+ <br />seal at ; evzi-d.XivAiAein said County, the date <br />