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rn <br /> m � � � <br /> rnm � y rn <br /> o �� � � �rn � rn <br /> a� �o rn �C p � <br /> o �z � � Z� � � <br /> o �� � � �Z �7 U] <br /> o ANGING STATEMENT z� � � �rn � — <br /> � i'RUCTIQNS �� � � �� � U] <br /> rn� rn �� � � <br /> H�NE DF C�NTACT AT F�LER(optivnal} rn� Q � =C� � C <br /> �o cn � � <br /> �� r� � <br /> 3NTAGT AT FILER(optianai} �� � �� � <br /> o� C3� (1] � <br /> CNDWLEDGMENT T�: �Name and Address} � Z <br /> � <br /> 1 � <br /> Exchange Bank <br /> 'I Z�4 Allen Dr <br /> P� �ox 5793 <br /> LGrand Is�and, NE 588�2 � <br /> THE AB�VE SPA�E IS F�R FILING C)FFICE USE�3NLY <br /> 1. DEBTC�R�S IVAME: Pro�ide only one Debtor r�ame�1a or 1b��use exact,f�l!narr�;do not omit,modify,or ahbreviate any part of the Debtor's name};if any part of the Indi�idual❑ebto�'s <br /> name will not fit in line 1 b,IQa�e al!of item 1 blank,check here � ar�d provide the Indi�idual Dehtor information in item 10 of the Finar�cing 5tatement Addend�rm(Form UCC'I Ad) <br /> � <br /> 1 a.OR�ANIZATIQN'S NAME <br /> RAYMaND J. Q'CaNNaR REVDCA6LE LIIIING TRUST <br /> �� 1 b.INDIVI�UA�`5 SLJRNAME FIRST PERS�NAL NAME ADDITI�NAL NAME[S)IIIV�TIAL[S) SLJFF�X <br /> 1c. MAILIN�A�DRESS CiTY STATE P�STAL CQOE C�IJNTRY <br /> B'�1 FLEETW��D RD GRANa ISLANa NE �8843-31'14 USA <br /> 2.DEBT4R'S NAME: Pro�ide o�ly ane Debtor name(2a or 2b}(use exact,full name;do not omi#,modify,or abbreviate any part af the Debtor's name};if any part of the Indi�idua�Debtor's <br /> name will t�ot f�t En line 2b,lea�e al1 af item 2 biank,check here � and pro�ide the Individual Debtar informat�on in item'IQ o�'tl�e Financing Statement Addendum(Form L1CC1Ad) <br /> 2a.�RGANIZATI�N'S NAME <br /> JENN�FER S. �'G�NN�R REV��ABLE LIVlNG TRUST <br /> �� 2�.INDIVIDUAL'S SURNAME FiRST PERS�NAL NAME ADD1TEaNAL NRME�S}IINITIA�(S} SLJFFIX <br /> 2c. MAIL�IVG AC]DRESS CITY STATE P�STAL C�DE C�IJNTRY <br /> s11 FLEETW�OD RD GRAND ISLANa NE 588�3�114 USA <br /> 3.SECURED PARTY�S NAME[or NAME of ASSI�NEE ofi ASSIGNt]R SECLJRED PARTY}: Pro�ide only ane Secured Parly name�3a or 3b) <br /> 3a.URGANIZATI�N'S NAME <br /> Exchange Bank <br /> aR 3b.INDIVIDIJAL'S SIJRNAME FIRST PERS�NRL NRME ADDlTI�NA�NAME{S}lINITiA�(S) SLJFFIX <br /> 3c. MAI�ING ADDRESS CITY STATE P�STAL C�DE C�LJNTRY <br /> 12Q4 Allen Dr,PD B�x 5793 �rand Is�and NE fi88�� USA <br /> 4.C�LLATERAL: This financing statement co�ers the fo�lowing collateral: <br /> � <br /> Assignment af Lease between RAYM�ND J. �'C�NN�Ft, TRLJSTEE �F THE RAYM�ND J. �'CONNaR REVaCABLE LIViNG TRUST �. <br /> JENNIFER S. �'CaNNOR, TRUSTEE �F THE JENNIFER S. �'CONN�R REI�DCABLE LIVING TRUST �Landlard� and SHaPK� STORES <br /> aPERATING CQ,,LL��Tenantj dated � � . <br /> 5.Check o_nly if applicable and check onl�one box: Collatera�is �held in a T�ust(see UCC1 Ad,item 17 and Instructions} heing administered hy a Decedent's Personal Represen#ative <br /> fia. Check o�i#applicable and check a�one box: fib.C�eck on�if applicable and check�one box: <br /> � Public-Finance Transactivn �Manufactured-Home Transaction � A Debtor is a Transmitting Lltility � Agricultural Lien �Non-UCC Fifing <br /> 7.A�TERIVATIVE DES��NATI�N(if applicable}: � LesseelLessor � ConsigneelConsignor � Sellerl8uyer � Bai(eelgailor � LicenseelLicensor <br /> 8.�PTI�NAL FILER REFERENCE DATA: <br /> FILING�FFICE C�PY—UCC FINANGING STATEMENT�Form U�C1}{Re�.04120111} �*H <br /> 4Q0 S.W. 6th A�enue,Portland,�regon 97ZQ4 <br />