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[Check applicable box(es)[ <br />200008614 <br />❑ Adjustable Rate Rider ❑ Condominium Rider ❑ 1-4 Family Rider <br />❑ Graduated Payment Rider ❑ Planned Unit Development Rider ❑ Biweekly Payment Rider <br />❑ Balloon Rider ❑ Rate improvement Rider ❑ Second Home Rider <br />® Other(s) [Specify] Assignment of Rents Rider <br />& Mortgage Insurance Rider <br />BY SIGNING BELOW, Borrower accepts and agrees to the terms and covenants contained in this Security Instrument and in any <br />rkler(s) executed by Borrower and recorded with it. <br />Witnesses: <br />STATE OF Nebraska <br />COUNTY OF Hall <br />rrower LeslieT Golka <br />(Seal) <br />Borrotvsr Bet J Wil <br />9 --5` � `� - (Seal) <br />Borrower John Heil Sr. <br />[Space Below This Line For Acknowledgment] <br />I SS: <br />(seal) <br />I, , a Notary Public in and for said county and state, do hereby <br />certify that Leslie C Golka an unmarried individual, and Betty J Heil and John Heil Sr, wife and husband <br />personally appeared before me and is (are) known to me to be the person(s) who, being informed of the contents of the foregoing <br />instrument, have executed same, and acknowledged said instrument to be his , free and voluntary act and deed <br />Is, her, t slr <br />and that he executed said instrument for the purposes A uses t Sin set forth. <br />(he, she, they) <br />Witness my hand and official seal this 13th day of October / 2000 <br />My Commission Expires: <br />This instrument was prepared <br />GENERAL NOTARY-State of Nebrask <br />SHERRI L. O'CALLAGHAI <br />?� My Comm. Exp. Sept. 28, 2003 <br />Form 3028 9/90 <br />F1029.1-MG (10/99) Page 5 of 5 <br />