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5. IN WTTNFISS WHEREOF, Mortgagee has executed this Agreement by signing on the (a) 12th j day
<br />of (b) A UPi's 1- _ ,(c) 20__4.
<br />BY (d)
<br />TITLE (e)
<br />t4-
<br />Ex. Vice President
<br />STATE Ol N H �$KA
<br />COMM" �F )
<br />(Title)
<br />My comtdission expires:
<br />b �
<br />Lee Jacobsen
<br />6. ACKNOWLEDGMENT
<br />This foregoing instrument was acknowledged before me this 12th
<br />August , 2014, by Lee Jacobsen, Ex. Vice President
<br />(Duly Authorized Officer)
<br />of PATHWAY BANK
<br />BEN M. NOTARY -State ' I
<br />LISA ESQUIVEL
<br />INyComm. Exp. May 1, 2018
<br />(Name of Mortgagee)
<br />rP -
<br />At t4 4 rt.A4All( 1
<br />General ' ary
<br />day of
<br />201405162
<br />NOTE: The following statement is made in accordance with the Privacy Act of 1974 (5 U.S.C. 552a - as amended). The authority for
<br />requesting the information identified pn this form is the Consolidated Farm and Rural Development Act, as amended (7 U.S.C.
<br />1921 t. seg.). The information will be used to determine eligibility and feasibility for loans and loan guarantees, and servicing of
<br />loans and loan guarantees. The informhation collected on this form maybe disclosed to other Federal, State, and local government
<br />agencies, Tribal agencies, and nongovernmental entities that have been authorized access to the information by statute or
<br />regulation and/or as described in the applicable Routine Uses identified. in the System of Records Notice for USDA/FSA -14,
<br />Applicant/Borrower. Providing the requested information is voluntary. However, failure to furnish the requested information may
<br />result in a denial for loans and loan guarantees, and servicing of loans and loan guarantees. The provisions of criminal and civil
<br />fraud privacy, and other statutes may be applicable to the information provided.
<br />Acco ing to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to
<br />respokid to, a collection of information unless it displays a valid OMB control number. The valid OMB control number: for this
<br />info ation collection is 0560-0237. The time required to complete this information collection is estimated to average 30 minutes
<br />per r sponse, including tire time for reviewing instructions, searching existing data sources, gathering and maintaining the data
<br />needed, and completing and reviewing the collection of information. RETURN MIS COMPLETED FORM TO YOUR COUNTY
<br />FSA OFFICE.
<br />The U.S. Department of Agriculture (USDA) prohibits discrimination in all its programs and activities on the basis of race, color, national origin, age,', disability, and
<br />where applicable, sex, marital status, familial status parental status, religion, sexual orientation, genetic information, political beliefs, reprisal, or because all or
<br />part of an individual's income is derived from any public assistance program. (Not all prohibited bases apply to all programs) Persons with disabilipes who
<br />require alternative means for communication of program information (Braille, large print audiotape, etc.) should contact USDA's TARGET Center at (202) 720-
<br />2600 (voice and Top. To file a complaint of discrimination, write to USDA, Assistant Secretary for Civil Rights, Office of the Assistant Secretary for Civil Rights
<br />1400 Independence Avenue, S.W., Stop 9410, Washington, DC 202504410, or call toll-free at (866) 632-9992 (English) or (800) 877-8339 (TDD) or (866) 377-
<br />8642 (English Federal- relay) or (800) 845 -6136 (Spanish Federal - relay). USDA is an equal opportunity provider and employer.
<br />FSA - 2319 (01- 11 -12) Page 2 of 2
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