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11fa ISNANONG SrATTUt" is premed to a fib"m OfLca <br />Na. of Additlanal. j ilfattarialr bate <br />fir Sawpsssaase a dw VRAN , Caimercial Code: bheet, lreletttat: i 1. tOattsaall- <br />L Deblois) (Lea Name fiwtl "d Addeawts): F ed Pastyliss;: Naeaelo-aatt Addresfa): 4. far no Ulcer. .. Trot. Date, <br />Grand Island health Care, Inc. can 4 N.. no Omer <br />wings - � :d. <br />3100 W. Faidley Ague ciation.o€ Iam <br />Grand Island, Nebraska 68803 rand Avenge <br />Des Mines, Iowa 50309 <br />SnNal Security No. F*dVA1 I.D. [ti0 <br />S. The Randle Statamem Gm the fallowing 77M !or fttas, of boyar: . <br />Bee Exhibit "A° attad W hereto and incorporated -by <br />this cue hexein. <br />6. Wt t k Rrgtdd is Rea: <br />t°esda— MgViucti'oi the Collat" am A.1a Cdreedi Er to Mtartgage Reoards <br />WO = }�El � . "B"' attached hereto and in rpo..ated � Reran <br />jQd � Island NQat �. Cam, Ihc. <br />9. Aadputctir -9 %$a ured tarty ad Addrems) <br />11. Tis stammer" is mod WhImati'aiac debtor's signature to Palm a, atrnrgq rnterst is eol4tm! <br />Rbeah ® if SO) <br />❑ afrcadr SwWtet to a 6=1ity int*tst in aootbr jutsdictiots when it was brwmtlr into thn state. or <br />❑ which is gretee& of the followiK.deaeorbe$ ar,•g;tW collateral which wat Perfected: <br />GO r <br />c American Federal s and Ioan <br />By By --^ r Assacit of I <br />,le ,� �cl C <br />crf�az <br />Spatate(1a d lk4tnxlx: n i _� C .fin n _ � t of etur gene 1� � �� <br />RI ifL L.� C 1 i tie ru;«1;ntonn, ASO. <br />FORM 801 to WjM OFMn COPY <br />1 <br />:ter: <br />rie f'. <br />J <br />