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OR
<br />l a. ORGANIZATIONS NAME
<br />TCK OF GRAND ISLAND, LLC
<br />1b. INDIVIDUAL'S SURNAME
<br />FIRST PERSONAL NAME
<br />ADDITIONAL NAME(S) /INITIAL(S)
<br />SUFFIX
<br />lc. MAILING ADDRESS
<br />1100 BUD BLVD
<br />CITY
<br />FREMONT
<br />STATE
<br />NE
<br />POSTAL CODE
<br />68025
<br />COUNTRY
<br />USA
<br />OR
<br />2a. ORGANIZATION'S NAME
<br />2b. INDIVIDUAL'S SURNAME
<br />FIRST PERSONAL NAME
<br />ADDITIONAL NAME(S) /INITIAL(S)
<br />SUFFIX
<br />2c. MAILING ADDRESS
<br />CITY
<br />STATE
<br />POSTAL CODE
<br />COUNTRY
<br />OR
<br />3a. ORGANIZATIONS NAME
<br />PINNACLE BANK
<br />3b. INDIVIDUAL'S SURNAME
<br />FIRST PERSONAL NAME
<br />ADDITIONAL NAME(S) /INITIAL(S)
<br />SUFFIX
<br />3c. MAILING ADDRESS
<br />99 W 6TH ST, PO BOX 668
<br />CITY
<br />FREMONT
<br />STATE
<br />NE
<br />POSTAL CODE
<br />68025
<br />COUNTRY
<br />USA
<br />A k
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<br />C
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<br />INANCING STATEMENT IN C7
<br />INSTRUCTIONS 1. V,"
<br />& PHONE OF CONTACT AT FILER (optional)
<br />. CONTACT AT FILER (optional)
<br />ACKNOWLEDGMENT TO: (Name and Address)
<br />INACLE BANK
<br />W 6TH ST PO BOX 668 •' �
<br />'FREMONT, NE 68025
<br />1
<br />3. SECURED PARTY'S NAME (or NAME of ASSIGNEE of ASSIGNOR SECURED PARTY): Provide only me Secured Party name (3a or 3b)
<br />FILING OFFICE COPY — UCC FINANCING STATEMENT (Form UCC1) (Rev. 04/20/11)
<br />L.)
<br />r te'
<br />Z.. —4
<br />- T1
<br />THE ABOVE SPACE IS FOR FILING OFFICE USE ONLY
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<br />CD
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<br />1. DEBTOR'S NAME: Provide only one Debtor name (la or l 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 tit in line 1b, leave ali of item 1 blank, check here 0 and provide the Individual Debtor information in item 10 of the Financing Statement Addendum (Form UCC1Ad)
<br />2. DEBTOR'S NAME: Provide only opg 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 0 and provide the Individual Debtor information in item 10 of the Financing Statement Addendum (Form UCC1Ad)
<br />4. COLLATERAL: This financing statement covers the following collateral:
<br />All inventory, equipment, accounts (including but not limited to all health -care- insurance receivables), chattel paper, instruments (including
<br />but not limited to all promissory notes), letter -of- credit rights, letters of credit, documents, deposit accounts, investment property, money,
<br />other rights to payment and performance, and general intangibles (including but not limited to all software and all payment intangibles); all
<br />oil, gas and other minerals before extraction; all oil, gas, other minerals and accounts constituting as- extracted collateral; all fixtures; all
<br />timber to be cut; all attachments, accessions, accessories, fittings, increases, tools, parts, repairs, supplies, and commingled goods relating
<br />to the foregoing property, and all additions, replacements of and substitutions for all or any part of the foregoing property; all insurance
<br />refunds relating to the foregoing property; all good will relating to the foregoing property; all records and data and embedded software
<br />relating to the foregoing property, and all equipment, inventory and software to utilize, create, maintain and process any such records and
<br />data on electronic media; and all supporting obligations relating to the foregoing property; all whether now existing or hereafter arising,
<br />whether now owned or hereafter acquired or whether now or hereafter subject to any rights in the foregoing property; and all products and
<br />proceeds (including but not limited to all insurance payments) of or relating to the foregoing property.
<br />5. Check only if applicable and check only one box: Collateral is 0 held in a Trust (see UCC1 Ad, item 17 and Instructions) ❑ being administered by a Decedent's Personal Representative
<br />6a. Check gtlly if applicable and check only one box: 6b. Check only if applicable and check only one box:
<br />❑ Public- Finance Transaction 0 Manufactured -Home Transaction El A Debtor is a Transmitting Utility 0 Agricultural Lien ❑ Non -UCC Filing
<br />7. ALTERNATIVE DESIGNATION (if applicable): ❑ Lessee /Lessor 0 Consignee/Consignor 0 Seller /Buyer 0 Bailee /Bailor ❑ Licensee/Licensor
<br />8. OPTIONAL FILER REFERENCE DATA:
<br />D +H
<br />400 S.W. 6th Avenue, Portland, Oregon 97204
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