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CCC -297 (03- 23 -12) IN WITNESS WHEREOF, the undersigned parties hereto have executed this instrument this (h) 14th day of (i) November if a corporation: /// (k) Name of Corporate (Mortgagee) (Owner) * (n) Individual (Mortgagee) (Owner) * CORPORATE SEAL (p) STATE OF Nebraska (q) COUNTY OF Hall (m) Title "Mortgagee" includes holder of any type of real estate lien. *Delete "Mortgagee" or "Owner." GENERAL NOTARY • Stale of Nebraska JONA L. DAILEY -BARR My Comm. Exp. March 9, 2020 (SEAL) My commission expires (w) Page 2 of 2 , 0) 2016 (year). O /// By y (1) Duly Authorized Officer (o) Individual (Mortg gee) (Owner) * } ss. ACKNOWLEDGMENT: 20160 7711 On this (r) 14th day of (s) November in the year (t) 2016 , before me, the undersigned, a Notary Public,in and for said State, personally appeared (u) -Sag A ond i1Ro& r etr 1.. iArclenCelit personally known to me or proved tore on the basis of satisfactory evidence to be the individual(s) whose name(s) is (are) subscribed to the within instrument and' acknowledged to me that he/she executed the same in his/her /their capacity (ies), and that by his/her /their signature(s) on the instrument, the individual(s) or the person on behalf of which the individual(s) acted, execute the instrument. (v) Notary Publi o 4354 (MM- NOTE: The following statement is made in accordance with the Privacy Act of 1974 (5 USC 5528 - as amended). The authority for requesting the information identified on this form is 7 CFR Part 1436, the Commodity Credit Corporation Charter Act (15 U.S. C. 714 et seq.), and the Food, Conservation, and Energy Act of 2008 (Pub. L 110 -246). The information will be used to obtain a Farm Storage Facility Loan Program severance agreement when there are real estate lien holders involving the land where a storage facility is to be located. The information collected on this form may be disclosed to other Federal, State, Local government agencies, Tribal agencies, and nongovernmental entities that have been authorized access to the information by statute or regulation and/or as described in applicable Routine Uses identified in the System of Records Notice for USDA/FSA -14, Applicant13orrower Providing the requested information is voluntary. However, failure to furnish the requested information will result in a determination of ineligibility for CCC financing under the Farm Storage Facility Loan Program.. This information collection is exempted from the Paperwork Reduction Act, as it is required for the administration of the Food, Conservation, and Energy Act of 2008 (see Pub. L 110 -246, Title 1, Subtitle F — Administration.. The provisions of appropriate criminal and civil fraud, privacy, and other statutes may be applicable to the information provided. RETURN THIS COMPLETED FORM TO YOUR COUNTY FSA OFFICE.