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2� 1 ��43� Hea�thcare Regulatory u.s. Department of Housing �MB Appraval No. ��o�-a�o� A reement— Borrow�r and Urban D��elopment �e�p.D��3�1��17} g �ffice of Res�dentia�l � SeCt�on �32 Care F�ci�it�es Public reporting burden for this cof�ection of information is estimated tfl average�.5 hours. This includes the time for collecting, reviewing,and reporting the data. The information is being collected#a ob#ain the sup�ortive documentation which must be submitted tv HU❑for appraval,and is necessary to ensur�thaf viab�e projects are developed and ma�ntained. The Department will use#his information to detenr�ine if properti�s meet HUD requi�ements with respect�v de�elopment,operation andlar asset management,as well as ensuring the cant�nued marketabilit�r of the properties. Th�s agency may not collec#this information,and you are not required t❑camplete this form, unless it displays a currently valid�MB con#rof number. Warning:Any person who knowingly presenfs a false,fctitious,or fraudulent statement or claim in a matter within the jurisdictEon a� the U.S.❑ep�rtment of Housing and Urban Deve�opment is subject to criminal penalties,ci�il liabi�ity,and administrative sanctions. Rec�rding requested by: Michael Dec�na � Kant�r Taylar Neison Evatt& I]ecina PC 90I 5t"Ave, Suite 4�� S eattl�, WA 9 S 154 After recording return t�: I�evin Muesenfechter �ffice �f Regional �ouns�l, Regian VII U.S. Department�f Hous�ng and Urban Development 4�� State Avenue, �ateway Tawer II, Room 51� � I�.ansas �ity, I�ansas �51�� Pro i ect Name: �ountryHouse of Gra�d Island FHA Pra'ect No.: 1�3-22��1 Prolect Location: Hail County,Nebraska Lender: Lancaster Pollard Mortgage ��mpany, LLC �ri ina�Pr�nci al Amount of Note: $4,13�,��.4� Date of Note: ' Septernber 1, ��16 �ri ina�l endorsed for in�urance under Se�tx�n Z3212�3 . Barrnwer: Prof�t-Mot�vated�� Non-Profit� . . . . . Failure to �heck the a ra riate s ace s shall n�t affect the enfarceabi��ty �r app�i�ation C PP � I� C ) of this Agreement.} Pre�Eous versions❑bsa�e#e Page '1 of 3G �orm HUD-9�4fiS-�RCF ��612D14}