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201807239 <br />CCC -297 (12-21-17) Page 2 of 2 <br />IN WITNESS WHEREOF, the undersigned parties hereto have executed this instrument <br />this (h) 1 / r day of (i) , (j) : Lk (year). <br />if a corporation: <br />n 1_ <br />R., `.3 <br />Pathway Bank <br />(k) Name of Corporate (Mortgagee) <br />By JJ- <br />/ <br />Chad Jacobsen <br />(1) Duly Authorized Officer <br />.5t•���e t n 0Y,cc.Q•' <br />(m) Title <br />CORPORATE <br />SEAL <br />(p) STATE OF /0BARS ic,A <br />(g) COUNTY OF /46 <br />On this (r) // iHday of (s) <br />Public in and for said State, personally appeared (u) <br />} ss. ACKNOWLEDGMENT: <br />e year , before me, the undersigned, a Notary <br />%i#)6 <JACo )E&✓ <br />personally known to me or proved to me on the basis of satisfactory evidence to be the individual(s) whose name(s) is (are) <br />subscribed to the within instrument and acknowledged to me that he/she executed the sa ` in his/her -ir capacity (ies), and <br />that by his/her/their signature(s) on the instrument, the individual(s) or the person on be of w e ' u divides .1(s) acted, <br />execute the instrument. <br />(SEAL) <br />BpNRAI NOTARY- State of Nebraska <br />WSKI <br />JOSEPHPHGRABOWSKI <br />RABOWSKI <br />My Comm. E. December 29, 2021 <br />My commission expires (w) <br />(v) Nota Public <br />a <br />-c7-da0o(l <br />(MM-DD-YYYY) <br />NOTE: The following statement is made in accordance with the Privacy Act of 1974 (5 USC 552a - as amended). The authority for requesting the information <br />identified on this form is 7 CFR Part 1436, the Commodity Credit Corporation Charter Act (15 U.S. C. 714 et seq.), and the Agricultural Act of 2014 <br />(Pub. L. 113-79). The information will be used to determine eligibility to participate in and receive benefits under the Farm Storage Facility Loan <br />Program through documentation of a severance agreement when there are real estate lien holders involving the land where a storage structure is to be <br />located. The information collected on this form may be disclosed to other Federal, State, Local govemment agencies, Tribal agencies, and <br />nongovernmental entities that have been authorized access to the information by statute or regulation and/or as described in applicable Routine Uses <br />identified in the System of Records Notice for USDA/FSA-14, Applicant/Borrower. Providing the requested information is voluntary. However, failure to <br />furnish the requested information will result in a determination of ineligibility to participate in and receive benefits under the Farm Storage Facility Loan <br />Program. <br />This information collection is exempted from the Paperwork Reduction Act, as specified in the Agricultural Act of 2014 (Pub. L. 113-79, Title 1 Subtitle F. <br />Administration). The provisions of criminal and civil fraud, privacy and other statutes may be applicable to the information provided. RETURN THIS <br />COMPLETED FORM TO YOUR COUNTY FSA OFFICE. <br />