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201508510
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12/17/2015 1:54:00 PM
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12/17/2015 1:54:00 PM
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201508510
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UCC FINANCING STATEMENT ADDENDUM <br />FOLLOW INSTRUCTIONS <br />AME OF FIRST DEBTOR: Same as line la or lb on Financing Statement; if line lb was left blank <br />ecause Individual Debtor name did not fit, check here <br />9a. ORGANIZATION'S NAME <br />9b. INDIVIDUAL'S SURNAME <br />Haeussler <br />FIRST PERSONAL NAME <br />Pamela <br />ADDITIONAL NAME(S)/INITIAL(S) <br />SUFFIX <br />9. N <br />OR <br />10. DEBTOR'S NAME: Provide (10a or 10b) only gL1g additional Debtor name or Debtor name that did not fit in line lb 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 />OR <br />10a. ORGANIZATION'S NAME <br />10b. INDIVIDUAL'S SURNAME <br />INDIVIDUAL'S FIRST PERSONAL 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 />Pamela Haeussler <br />1616 Hagge Ave <br />Grand Island, NE 68801 <br />17. MISCELLANEOUS: <br />FILING OFFICE COPY — UCC FINANCING STATEMENT ADDENDUM (Form UCC1Ad) (Rev. 04/20/11) <br />20150851.0 <br />THE ABOVE SPACE IS FOR FILING OFFICE USE ONLY <br />14. This FINANCING STATEMENT: <br />El covers timber to be cut [J covers as- extracted collateral m is filed as a fixture filing <br />16. Description of real estate: <br />Legal Description: BARTLING'S SUB N 1/2 LT 6 BLK 2 <br />County: HALL, NE APN: 400015366 <br />Census Tract / Block: 9.00 / 2 Alternate APN: <br />3315 -00 -0- 10270- 002 -0008 <br />Township- Range -Sect: Subdivision: BARTLINGS SUB <br />Legal Book/Page: Map Reference: / <br />Legal Lot: 6 Tract #: <br />Legal Block: 2 School District: <br />Market Area: School District Name: <br />Corporation Service Company <br />2711 Centerville Rd, Ste. 400 <br />Wilmington, DE 19808 <br />INDIVIDUAL'S ADDITIONAL NAME(S) /INITIAL(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 or • ASSIGNOR SECURED PARTY'S NAME: Provide only ong name (11a or 11 b) <br />11a. ORGANIZATIONS NAME <br />11 b. 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 lb on Financing Statement; if line lb was left blank <br />ecause Individual Debtor name did not fit, check here <br />9a. ORGANIZATION'S NAME <br />9b. INDIVIDUAL'S SURNAME <br />Haeussler <br />FIRST PERSONAL NAME <br />Pamela <br />ADDITIONAL NAME(S)/INITIAL(S) <br />SUFFIX <br />9. N <br />OR <br />10. DEBTOR'S NAME: Provide (10a or 10b) only gL1g additional Debtor name or Debtor name that did not fit in line lb 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 />OR <br />10a. ORGANIZATION'S NAME <br />10b. INDIVIDUAL'S SURNAME <br />INDIVIDUAL'S FIRST PERSONAL 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 />Pamela Haeussler <br />1616 Hagge Ave <br />Grand Island, NE 68801 <br />17. MISCELLANEOUS: <br />FILING OFFICE COPY — UCC FINANCING STATEMENT ADDENDUM (Form UCC1Ad) (Rev. 04/20/11) <br />20150851.0 <br />THE ABOVE SPACE IS FOR FILING OFFICE USE ONLY <br />14. This FINANCING STATEMENT: <br />El covers timber to be cut [J covers as- extracted collateral m is filed as a fixture filing <br />16. Description of real estate: <br />Legal Description: BARTLING'S SUB N 1/2 LT 6 BLK 2 <br />County: HALL, NE APN: 400015366 <br />Census Tract / Block: 9.00 / 2 Alternate APN: <br />3315 -00 -0- 10270- 002 -0008 <br />Township- Range -Sect: Subdivision: BARTLINGS SUB <br />Legal Book/Page: Map Reference: / <br />Legal Lot: 6 Tract #: <br />Legal Block: 2 School District: <br />Market Area: School District Name: <br />Corporation Service Company <br />2711 Centerville Rd, Ste. 400 <br />Wilmington, DE 19808 <br />
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