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SIGNATURE AND ACKNOWLEDGMENT <br />Agent' Si <br />L <br />Ag g 'are Date <br />Agent's Name Printed: <br />Agent's Address: 1 <br />Agent's Telephone Number: 0 it • "L l► �(, g d <br />This document was acknowledged before me on oPS day of M� , 010(7 , <br />by Ti Rfary QaJ. � ren (Name of Agent). <br />GENERAL NOTARY • State of Nebraska <br />MICHELE E BLAGDON <br />My Comm. Exp. May 11, 2020 <br />This document prepared by: P. Stephen Potter P.C. <br />�• `2S -2O <br />Signature of Notary <br />My commission expires: <br />6 /f d6AG <br />201707117 <br />