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UCC FINANCING STATEMENT ADDENDUM <br />FOLLOW INSTRUCTIONS <br />9. NAME <br />because <br />OR <br />OF FIRST DEBTOR: Same as line la or 1b on Financing Statement; if line 1b was left blank <br />Individual Debtor name did not fit, check here <br />9a. ORGANIZATION'S NAME <br />9b. INDIVIDUAL'S SURNAME <br />FISHER <br />FIRST PERSONAL NAME <br />JACKIE <br />ADDITIONAL NAME(S)/INITIAL(S) <br />SUFFIX <br />2020061J2 <br />THE ABOVE SPACE IS FOR FILING OFFICE USE ONLY <br />10. DEBTOR'S NAME: Provide (10a or 10b) only gfg additional Debtor name or Debtor name that did not fit in line 1b or 2b of the Financing Statement (Form UCC1) (use exact, full name; <br />do not omit, modify, or abbreviate any part of the Debtor's name) and enter the mailing address in line 10c <br />OR <br />10a. ORGANIZATION'S NAME <br />10b. INDIVIDUAL'S SURNAME <br />INDIVIDUAL'S FIRST PERSONAL NAME <br />INDIVIDUAL'S ADDITIONAL NAME(S)/INITIAL(S) <br />SUFFIX <br />10'c. MAILING ADDRESS <br />CITY <br />STATE <br />POSTAL CODE <br />COUNTRY <br />11.. <br />OR <br />ADDITIONAL SECURED PARTY'S NAME <br />of <br />• <br />ASSIGNOR SECURED PARTY'S NAME: Provide only one name (11a or 11b) <br />11a. ORGANIZATION'S NAME <br />11b. INDIVIDUAL'S SURNAME <br />FIRST PERSONAL NAME <br />ADDITIONAL NAME(S)/INITIAL(S) <br />SUFFIX <br />11c. MAILING ADDRESS <br />CITY <br />STATE <br />POSTAL CODE <br />COUNTRY <br />12. ADDITIONAL SPACE FOR ITEM 4 (Collateral) <br />2703 W JOHN GRAND ISLAND NE 68803 <br />THIS FILING IS MADE FOR NOTICE PURPOSES ONLY. THE DEBTOR HAS NO OWNERSHIP RIGHTS IN THE <br />- COLLATERAL. <br />THE DEBTOR IS LEASING THE COLLATERAL. <br />13. ❑ This FINANCING STATEMENT is to be filed [for record] (or recorded) in the <br />REAL ESTATE RECORDS (if applicable) <br />14. This FINANCING STATEMENT: <br />covers timber to be cut covers as -extracted collateral 1=1 is filed as a fixture filing <br />15. Name and address of a RECORD OWNER of real estate described in item 16 <br />JACKIE FISHER a record interest) <br />2703 W JOHN ST <br />GRAND ISLAND NE 68803 <br />16. Description of real estate: <br />A PARCEL OF LAND LOCATED IN THE STATE OF NE, COUNTY <br />OF HALL, WITH A SITUS ADDRESS OF 2703 W JOHN ST, <br />GRAND ISLAND NE <br />68803-5710 CO24 CURRENTLY OWNED BY FISHER <br />DOCKHORN JACQUELINE HAVING A TAX ASSESSOR <br />NUMBER OF 400136228 AND BEING <br />THE SAME PROPERTY MORE FULLY DESCRIBED AS <br />GLADSTONE PLACE LT 1 BLK 7 <br />17. MISCELLANEOUS: <br />FILING OFFICE COPY — UCC FINANCING STATEMENT ADDENDUM (Form UCC1Ad) (Rev. 04/20/11) <br />