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FOR USE IN THE STATE OF NEBRASKA �! ( PAGE 2 OF 4 INSTALLMENT SALES CONTRACT AND MORTGAGE i (� SALES 125532 CONTRACT NO. You (Seller/ Mortgagee) have quoted me (Buyer[s] /Mortgagor[s]) a Cash Price and a Total Sale Price for the Products described on page l of this contract. The Total Sale Price is the total cost of the Products and services if I buy on credit, subject to approval of my credit. I (Buyer) now choose to buy and you agree to sell, for the Total Sale Price set forth below, the Products and services described on page 1. I agree to pay you the Amount Financed in accordance with the payment schedule set forth below, together with interest thereon at the annual percentage rate disclosed below. SUMMARY OF SALE: Base cash price $ , �•�� + tax 1 $ D- o Total cash price $ J D - ucz — Cash [total] down payment ,, — Unpaid balance of $ I &ro - 0 d . ITEMIZATION OF THE AMOUNT FINANCED OF $ $ d 171) Amount credited to this contract (Same amount as the "Unpaid Balance. ") 2 0 0 0 0 8 8 6 3 $ c9D r 0 D Amount paid on net balance from prior contract with you. (e) Amount(s) paid to others on my behalf: $ c2/7 -�9 J to insurance company for Credit Life insurance $ ✓ .0, 00 to public officials four filing /recording fees (e) $ B2� to insurance company for Accident and Health insurance $ 2 -0,2 to (Specify) f > J /e 5e _ 4 ANNUAL FINANCE Amount Financed Total of Payments Total Sale Price PERCENTAGE CHARGE The amount of credit The amount I will have The total cost of my purchase RATE The dollar amount the provided to me or on paid after I have made all on credit, including my down The cost of my credit as a credit will cost me. my behalf. payments as scheduled. payment of $ Q� C2r7 . yearly rate. $ $ $ $ S• .S^ % aa? / ` ads / ,do 1 -%/ i, av My payment schedule will be: Number of Payments Amount of Payments When Payments are Due 1st Payment $ a First payment due $ �� , All subsequent installments on the same day of each consecutive month until paid in full. INSURANCE Credit life insurance and credit disability insurance are NOT required to obtain credit, and will not be provided unless I sign and agree to pay the additional cost. Type Premium Tee , Signature Credit Life I want credit life $ insurance. Signature — Buyer e i 0 p B re — Co -Buyer Credit Accident I want credit accident & Health $ and health insurance. 4D I 'Ind t9 Signature — Buyer Security: I am giving you: 1. a security interest in the goods, services and property being purchased, and 2. a mortgage on my real estate at my "ADDRESS" below and legally described on page 3 hereof Filing/Recording fees $ le ..9 d Late Charge: If a payment is more than fifteen (15) days late, I will be charged 5% of the installment payment or $25.00 whichever is lesser. Prepayment: If I pay off early, I will not have to pay a penalty. ► I will review other portions of this contract for additional information about non - payment, default, any required repayment in full before the scheduled date, and `prepayment refunds and penalties. e means an estimate. MORTGAGE: I hereby grant, bargain, sell, convey and mortgage to you, as Mortgagee, my real estate at my "Address" below and as more particularly described on page 3 (reverse side) of this contract as security for all amounts due to you under this Installment Sales Contract and Mortgage. I hereby grant to you a power of attorney to insert the legal description of my real estate hereontat a later time. CONSOLIDATION: If I now have a balance due you from a previous purchase, I understand I must continue to make my payments on that obligation until payments begin under this Contract. REVERSE SIDE: I UNDERST %k1JNE.ADD.LT TERMS AyyD PROVISIONS PRINTED ON PAGES 1, 3 AND 4 OF THIS INSTALLMENT SALES CONTRACT AND MORTGAGED P R F THIS 1tSTAUL NT ALES CONNACT AND MORTGAGE AND THAT I AM BOUND BY THEM. NOTICE: PROVISIONS PRINTED ON PAGES 1, 3 fail, MS IMITING SELLER'S WARRANTY OBLIGATION. '` ' _ NOTICE TO BUYER 1. DO NOT SIGN.Tkuxim OR IF IT CONTAINS BLANK SPACES. 2. I AM ENTITLED TO A COPY OF THE CONTRACT I SIGNED. 3. 1 MAY PAY OFF THE FULL BALANCE DUE UNDER THIS CONTRACT AT ANY TIME, AND IN SO DOING I MAY BE ENTITLED TO A REBATE OF THE UNEARNED FINANCE AND INSURANCE CHARGES (IF ANY). 4. 1 UNDERSTAND THAT THIS INSTRUMENT IS BASED UPON A HOME SOLICITATION SALE AND THAT THIS INSTRUMENT IS NOT NEGOTIABLE. 5. IT SHALL NOT BE LEGAL FOR YOU TO ENTER MY PREMISES UNLAWFULLY OR COMMIT ANY BREACH OF THE PEACE TO REPOSSESS GOODS PURCHASED UNDER THIS CONTRACT. BUYER'S RIGHT TO CANCEL I HAVE BEEN ORALLY ADVISED THAT I MAY CANCEL THIS AGREEMENT AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION. (I HAVE READ THE ACCOMPANYING NOTICE OF RIGHT TO CANCEL FORM FOR AN EXPLANATION OF THIS RIGHT.) COPY RECEIVED: I acknowledge receipt of a completely filled in copy of this contract along with two (2) copies of the Notice of Right to Cancel Form. tZ dJ IN WITNESS WHEREOF, this Installm�e/nt Sales Contract and Mortgage has been signed on this ,�� _ day of BUYER'S "ADDRESS" d °� 7 S o c, 5 1 City 4 H /,, K County Telephone No. 3 0 e - 3 p ;? ' Yl -1 f THE PACESETTER CORPORATION (SELLER — MORTGAGEE) By: .6 HORI OFFICER) By: (FACT RY REP SENTATIVE) 7039 SM- 101- NE -H /IE PAGE 2 State Zip Z W& % BI}'rERERR = MORTGAGOR" ff P, &l,o S B ER- MORTGAGOR PRI TED NAME � �< �- -cam G✓� Z Z �-y CO -BUY R — MORTGAGOR ee mvS CO- BUYER- MORTGAGOR — PRINTED NAME ORIGINAL FINANCIAL INSTITUTION