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<br />5. IN WITNESS WHEREOF, Mortgagee has executed this Agreement by signing on the (a) 1 t o day
<br />of (b) . . i \3 , /&
<br />STATE OF NEBRASKA
<br />COUNTY OF )
<br />This foregoing instrument was acknowledged before me this ) 1Q h day of
<br />, 201L, by — p--
<br />J (Duly Authorized Officer)
<br />of � t c-r Cr �G -c Stu t S a4 /a. i t_a. t c o, (r (..(Q
<br />(Name of Mortgagee)
<br />crack; e-k O i c
<br />(Title)
<br />My commission expires:
<br />6. ACKNOWLEDGMENT
<br />General Notary
<br />LO A .4 I c_ r c1
<br />20180460
<br />NOTE: The following statement is made in accordance with the Privacy Act of 1974 (5 U.S.C. 552a - as amended). The authority for
<br />requesting the information identified on this form is the Consolidated Farm and Rural Development Act, as amended (7 U.S. C.
<br />1921 et. sea.). The information will be used to determine eligibility and feasibility for loans and loan guarantees, and servicing of
<br />loans and loan guarantees. The information collected on this form may be disclosed to other Federal, State, and local government
<br />agencies, Tribal agencies, and nongovernmental entitles that have been authorized access to the information by statute or
<br />regulation and/or as described in the applicable Routine Uses Identified in the System of Records Notice for USDAIFSA -14,
<br />Applicant/Borrower. Providing the requested information is voluntary. However, failure to furnish the requested information may
<br />result in a denial for loans and loan guarantees, and servicing of loans and loan guarantees. The provisions of criminal and civil
<br />fraud, privacy, and other statutes maybe applicable to the information provided.
<br />According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to
<br />respond to, a collection of information unless it displays a valid OMB control number. The valid OMB control number for this
<br />information collection is 0560-0237. The time required to complete this information collection is estimated to average 30 minutes
<br />per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data
<br />needed, and completing and reviewing the collection of information. RETURN THiS COMPLETED FORM TO YOUR COUNTY
<br />FSA OFFICE.
<br />The U.S. Department of Agriculture (USDA) prohibits descdminaffon In all its programs and ac5vities on the bests of race, color, national origin, age, disability, and
<br />where applicable, sex, marital status, familial status, parental status, religion, sexual orientaion, genetic irlformaiio,1, poetical beliefs, reprisal, or because all or
<br />part of an individual's income is derived from any public assistance program. (Not all prohibited bases apply to all programs.) Persons with disabiliffes who
<br />require alternative means for communication of program information (Braille, large print, audiotape, etc.) should contact USDA's TARGET Center at (202) 720-
<br />2600 (voice and TDD). To file a complaint of discrimination, write to USDA, Assistant Secretary for Civil Rights, Office of the Assistant Secretary for Civil Rights,
<br />1400 Independence Avenue, S.W, Stop 9410, Washington, DC 20250 -9410, or call toff-free at (666) 632 -9992 (English) or (800) 877 -8339 (TDD) or (866)377-
<br />E3642 (English Federal - relay) or (800) 845 -6136 (Spanish Federal- relay). USDA is an equal opportunity provider and employer.
<br />FSA - 2319 (01- 11 -12) Page 2 of 2
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