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v " <br />10b INDIVIDUAL'S SURNAME <br />INDIVIDUAL'S FIRST PERSONAL NAME <br />INDIVIDUAL'S ADDITIONAL NAME(S)ANITIAL(S) <br />SUFFIX <br />10c. MAILING ADDRESS <br />CITY <br />STATE <br />POSTAL CODE <br />COUNTRY <br />11. <br />OR <br />❑ ADDITIONAL SECURED PARTY'S NAME <br />gl <br />$ <br />ASSIGNOR SECURED PARTY'S NAME: Provide only gm name (11a or 11b) <br />11a. ORGANIZATIONS NAME <br />11b. INDIVIDUAL'S SURNAME <br />FIRST PERSONAL NAME <br />ADDITIONAL NAME(S)/INITIAL(S) <br />SUFFIX <br />11c. MAILING ADDRESS <br />CITY <br />STATE <br />POSTAL CODE <br />COUNTRY <br />UCC FINANCING STATEMENT ADDENDUM <br />FOLLOW INSTRUCTIONS <br />AME OF FIRST DEBTOR: Same as line la or 1b on Financing Statement; if line 1b was left blank <br />because Individual Debtor name did not fit, check here ❑ <br />9a. ORGANIZATION'S NAME <br />T & J Tires and Associates, LLC <br />9b. INDIVIDUAL'S SURNAME <br />FIRST PERSONAL NAME <br />ADDITIONAL NAME(S)/INITIAL(S) <br />SUFFIX <br />9. N <br />OR <br />10. DEBTOR'S NAME: Provide (10a or 10b) only gna additional Debtor name or Debtor name that did not fit in line 1 b or 2b of the Financing Statement (Form UCC1) (use exact, full name; <br />do not omit, modify, or abbreviate any part of the Debtor's name) and enter the mailing address in line 10c <br />10a. ORGANIZATION'S NAME <br />12. ADDITIONAL SPACE FOR ITEM 4 (Collateral): <br />13. m This FINANCING STATEMENT is to be filed [for record] (or recorded) in the <br />REAL ESTATE RECORDS (if applicable) <br />15. Name and address of a RECORD OWNER of real estate described in item 16 <br />(if Debtor does not have a record interest): <br />17. MISCELLANEOUS: <br />16. Description of real estate: <br />FILING OFFICE COPY — UCC FINANCING STATEMENT ADDENDUM (Form UCC1Ad) (Rev. 04/20/11) <br />201404099 <br />THE ABOVE SPACE IS FOR FILING OFFICE USE ONLY <br />14. This FINANCING STATEMENT: <br />❑ covers timber to be cut ❑ covers as- extracted collateral ❑ is filed as a fixture filing <br />The southerly two hundred feet (200') of Lot Thirteen (13) Menard <br />Second Subdivision, in the City of Grand Island, Hall County, <br />Nebraska. <br />Corporation Service Company <br />2711 Centerville Rd, Ste. 400 <br />W rnington. DE 19808 <br />