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ANCING STATEME I tIT <br />iTRUCTIONS <br />L <br />HONE OF CONTACT AT FILER (optional) <br />(800) 331-3282 Fax: (818) 662 -4141 <br />DNTACT AT FILER (optional) <br />- LS_Glendale_ Customer _Service @wolterskiuwer.com <br />nn <br />m ti <br />0 <br />Q <br />KNOWLEDGMENT TO: (Name and Address) 25677 - Citizens State <br />51164659 — 1 <br />NENE <br />FIXTURE <br />File with: Hall County Register of Deeds, NE <br />1. DEBTORS NAME: Provide only one Debtor name (la or lb) (use exact, full name; do not omit, modify, or abbreviate any part of the Debtor's name); if any part of the Individual Debtor's <br />name will not tit in line 1b, leave all of item 1 blank, check here ID and provide the Individual Debtor information in item 10 of the Financing Statement Addendum (Form UCCIAd) <br />CT 13n Solutions (... \I <br />P.O. Box 29071 <br />Glendale, CA 91209 -9071 <br />THE ABOVE SPACE IS FOR FILING OFFICE USE ONLY <br />M' <br />iTi <br />C.r) <br />Cr) <br />C.d7 <br />CD <br />CO <br />1.-_• r1 <br />cga <br />0 <br />1 a. ORGANIZATION'S NAME <br />1b. INDIVIDUAL'S SURNAME <br />BARCENAS <br />MAILING ADDRESS <br />FIRST PERSONAL NAME <br />CARLOS <br />CITY <br />ADDITIONAL NAME(S)/INITIAL(S) <br />STATE <br />POSTAL CODE <br />OR <br />lc. <br />OR <br />2c. <br />3. SECURED PARTY'S NAME (or NAME of ASSIGNEE of ASSIGNOR SECURED PARTY): Provide only one Secured Party name (3a or 3b) <br />OR <br />3c. <br />6500 SW Archer Rd Ste H <br />_ 4. COLLATERAL: This financing statement covers the following collateral: <br />HVAC <br />FILING OFFICE COPY — UCC FINANCING STATEMENT (Form UCC1) (Rev. 04/20/11) <br />SUFFIX <br />COUNTRY <br />1415 W 4TH ST GRAND ISLAND NE 68801 USA <br />2. DEBTORS NAME: Provide only one Debtor name (2a or 2b) (use exact, full name; do not omit, modify, or abbreviate any part of the Debtor's name); if any part of the Individual Debtor's <br />name will not fit in line 2b, leave all of item 2 blank, check here and provide the Individual Debtor information in item 10 of the Financing Statement Addendum (Form UCCIAd) <br />2a. ORGANIZATION'S NAME <br />2b. INDIVIDUAL'S SURNAME <br />MAILING ADDRESS <br />FIRST PERSONAL NAME <br />CITY <br />ADDITIONAL NAME(S)/INITIAL(S) <br />STATE <br />POSTAL CODE <br />SUFFIX <br />COUNTRY <br />3a. ORGANIZATION'S NAME <br />Citizens State Bank <br />3b. INDVIDUAL'S SURNAME <br />MAILING ADDRESS <br />FIRST PERSONAL NAME <br />CITY <br />Gainesville <br />ADDITIONAL NAME(SyINITIAL(S) <br />STATE <br />FL <br />POSTAL CODE <br />32608 <br />SUFFIX <br />COUNTRY <br />USA <br />5. Check only if applicable and check only one box: Collateral is Q held in a Trust (see UCC1Ad, item 17 and Instructions) Qbeing administered by a Decedents Personal Representative <br />6a. Check oak if applicable and check on one box: 6b. Check .orA if applicable and check o_l_k one box: <br />Public - Finance Transaction ❑ Manufactured -Home Transaction ❑ A Debtor is a Transmitting Utility ❑ Agricultural Lien ❑ Non -UCC Filing <br />7. ALTERNATIVE DESIGNATION (if applicable): 0 Lessee /Lessor 0 Consignee /Consignor 0 Seller /Buyer fl Bailee /Bailor fl Licensee/Licensor <br />8. OPTIONAL FILER REFERENCE DATA: <br />51164659 1277478 <br />Prepared by CT Lien Solutions, P.O. Box 29071, <br />Glendale, CA 91209 -9071 Tel (800) 331 -3282 <br />