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'INANCING STATEMENT AMENDMENT INSTRUCTIONS & PHONE OF CONTACT AT FILER (optional) n Baldwin L CONTACT AT FILER (optional) 1 ACKNOWLEDGMENT TO: (Name and Address) __rritage Bank 800 W 3rd Street Hastings, NE 68901 L 1 a. INITIAL FINANCING STATEMENT FILE NUMBER 1 b. This FINANCING STATEMENT AMENDMENT is to be filed [for record] 020060431 (or recorded) in the REAL ESTATE RECORDS Filer: gaggti Amendment Addendum (Form UCC3Ad) ang provide Debtors name in fern 13 2. fJ TERMINATION: Effectiveness of the Financing Statement identified above is terminated with respect to the security interest(s) of Secured Party authorizing this Termination Statement 3. ❑ ASSIGNMENT (full or partial): Provide name of Assignee in item 7a or 7b, mg address of Assignee in item 7c mg name of Assignor in item 9 For partial assignment, complete items 7 and 9 gns also indicate affected collateral in item 8 4. ❑ CONTINUATION: Effectiveness of the Financing Statement identified above with respect to the security interests) of Secured Party authorizing this Continuation Statement is continued for the additional period provided by applicable law 5. ❑ PARTY INFORMATION CHANGE: Check gag of these two boxes: CHANGE name and/or address: Complete This Change affects ❑ Debtor gr ❑ Secured Party of record ❑ item 6a or 6b; gag item 7a or 7b eng item 7c 6. CURRENT RECORD INFORMATION: Complete for Party Information Change - provide only gag name (6a or 6b) 6a. ORGANIZATIONS NAME GRAND ISLAND REGENCY RETIREMENT 6b. INDIVIDUAL'S SURNAME FIRST PERSONAL NAME ADDITIONAL NAME(S)/INITIAL(S) OR 7. CHANGED OR ADDED INFORMATION: Complete for Assignment or Party Information Change • provide only ont name (7a or 7b) (use exact NO name; do not omit modify, or abbreviate any part of the Debtors name) OR OR 7a. ORGANIZATION'S NAME 7b. INDIVIDUAL'S SURNAME INDIVIDUAL'S FIRST PERSONAL NAME INDIVIDUAL'S ADDITIONAL NAME(S)/INITIAL(S) 7c. MAILING ADDRESS 8. ❑ COLLATERAL CHANGE: Also check one of these four boxes: ❑ ADD collateral ❑ DELETE collateral ❑ RESTATE covered collateral ❑ ASSIGN collateral Indicate collateral: SEE EXHIBITS "A " AND "B" ATTACHED HERETO. 9. NAME OF SECURED PARTY OF RECORD AUTHORIZING THIS AMENDMENT: Provide only gni name (9a or 9b) (name of Assignor, If this is an Assignment) If this is an Amendment authorized by a DEBTOR, check here ❑ and provide name of authorizing Debtor 9a. ORGANIZATIONS NAME HERITAGE BANK 9b. INDIVIDUAL'S SURNAME FIRST PERSONAL NAME ADDITIONAL NAME(S) /INITIAL(S)' 10. OPTIONAL FILER REFERENCE DATA: gj(Q Check gag of these three boxes to: CITY n n et a c c> C A -o Co o -n z r :n s- '1t F--► C*) CD ;? (.J-I Cara en THE ABOVE SPACE IS FOR FILING OFFICE USE ONLY ADD name: Complete item DELETE name: Give record name 7a or 7b, gn4 item 7c ❑ to be deleted in item 6a or 6b STATE POSTAL CODE SUFFIX SUFFIX COUNTRY SUFFIX International Association of Commercial Administrators (IACA) FILING OFFICE COPY — UCC FINANCING STATEMENT AMENDMENT (Form UCC3) (Rev. 04/20/11)