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e <br />N Z <br />e J ^ C <br />UT , `, ~i A (j) <br />0 tI� INANCING STATEMENT V 2 <br />CO INSTRUCTIONS a--. I <br />W <br />oar <br />1. DEBTOR'S NAME: Provide only only Debtor name (la or 1 b) (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 1b, leave all of item 1 blank, check here ❑ and provide the Individual Debtor information in Item 10 of the Financing Statement Addendum (Form UCC1Ad) <br />la. ORGANIZATION'S NAME <br />1b. INDIVIDUAL'S SURNAME <br />Hooker <br />MAILING ADDRESS <br />134 Elmwood Drive <br />FIRST PERSONAL NAME <br />Scott <br />CITY <br />Grand Island <br />ADDITIONAL NAMES) /INITIAL(S) <br />A. <br />STATE <br />NE <br />POSTAL CODE <br />68803 <br />OR <br />1c. <br />4 <br />2. DEBTOR'S NAME; Provide only one Debtor name (2a or 2b) (use exact, full name; do not omit, modify, or abbreviate any part of the Debtors 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 UCC1Ad) <br />2a. ORGANIZATION'S NAME <br />2b. INDIVIDUAL'S SURNAME <br />Hooker <br />MAILING ADDRESS <br />134 Elmwood Drive <br />FIRST PERSONAL NAME <br />Susan <br />CITY <br />Grand Island <br />ADDITIONAL NAME(SyINITIAL(S) <br />L. <br />STATE <br />NE <br />POSTAL CODE <br />68803 <br />OR <br />2c. <br />4 <br />OR <br />L <br />& PHONE OF CONTACT AT FILER (optional) <br />L CONTACT AT FILER (optional) <br />ACKNOWLEDGMENT TO: (Name and Address) <br />Heritage Bank <br />PO B. , 21 2nd Street <br />St. ' : , ' 68873 t' <br />3. SECURED PARTY'S NAME (or NAME of ASSIGNEE of ASSIGNOR SECURED PARTY): Provide only= Secured Party name (3a or 3b) <br />3c. MAILING ADDRESS <br />PO BOX 5138 <br />4. COLLATERAL: This financing statement covers the following collateral: <br />— Home Located at 3840 S Locust St., Grand Island, NE 68801 <br />FILING OFFICE COPY — UCC FINANCING STATEMENT (Form UCC1) (Rev. 04/20/11) <br />' >r <br />CID <br />C ._) <br />C7) <br />THE ABOVE SPACE IS FOR FILING OFFICE USE ONLY <br />I ND <br />I—� <br />CJl <br />CD <br />-r] <br />CD <br />CT) <br />() <br />SUFFIX <br />COUNTRY <br />USA <br />SUFFIX <br />COUNTRY <br />USA <br />3a. ORGANIZATION'S NAME <br />Heritage Bank <br />3b. INDIVIDUAL'S SURNAME <br />FIRST PERSONAL NAME <br />CITY <br />GRAND ISLAND <br />ADDITIONAL NAME(S)/INITIAL(S) <br />STATE <br />NE <br />POSTAL CODE <br />68802 <br />SUFFIX <br />COUNTRY <br />USA <br />5. Check WI N applicable and check gDly one box: Collateral is ❑ held In a Trust (see UCC1Ad, Item 17 and Instructions) Ej being administered by a Decedents Personal Representative <br />6a. Check QDly If applicable and check say one box: 6b. Check g01x if applicable and check only one box: <br />E l Public Finance Transaction 0 Manufactured - Home Transaction 0 A Debtor Is a Transmitting Utility ❑ Agricultural Lien 0 Non - UCC Filing <br />7. ALTERNATIVE DESIGNATION (if applicable): 0 Lessee/Lessor ❑ Consignee /Consignor 0 Seiler/Buyer 0 Settee/Bailor 0 Licensee/Licensor <br />8. OPTIONAL FILER REFERENCE DATA: <br />International Association of Commercial Administrators (IACA) <br />