Laserfiche WebLink
B ■ <br />A <br />A 'INANCING STATEMENT <br />N- INSTRUCTIONS <br />'CSC Pb P a296.9‘ <br />Springfield, IL- <br />toa7o2 •949 <br />m <br />m <br />& PHONE OF CONTACT AT FILER (optional) <br />; 1-800-858-5294 <br />L CONTACT AT FILER (optional) <br />tFiling@cscglobal.com <br />ACKNOWLEDGMENT TO: (Name and Address) <br />5 38576 OD <br />Filed In: Nebraska <br />(Hall) I <br />Ci) <br />) <br />c) <br />-C <br />THE ABOVE SPACE IS FOR FILING OFFICE USE ONLY <br />tV <br />CD <br />N <br />I—S <br />O <br />CD <br />CD <br />N <br />0 <br />1. DEBTORS NAME: Provide only one Debtor name (la or 1b) (use exact, full name; do not omit, modify, or abbreviate any part of the Debtors name); if any part of the Individual Debtors <br />name will not fit in line 1 b, leave all of item 1 blank, check here 0 and provide the Individual Debtor information in item 10 of the Financing Statement Addendum (Form UCCIAd) <br />la. ORGANIZATION'S NAME <br />OR <br />lb. INDIVIDUAL'S SURNAME <br />JONES <br />FIRST PERSONAL NAME <br />PATRICIA <br />ADDITIONAL NAME(S)/INITIAL(S) <br />L <br />SUFFIX <br />lc. MAILING ADDRESS 429 RENEE RD <br />CITY <br />DONIPHAN <br />STATE <br />NE <br />POSTAL CODE <br />68832 <br />COUNTRY <br />USA <br />2. DEBTOR'S NAME: Provide only QDg Debtor name (2a or 2b) (use exact, full name; do not omit, modify, or abbreviate any part of the Debtors name); if any part of the Individual Debtors <br />name will not fit in line 2b, leave all of item 2 blank, check here 0 and provide the Individual Debtor information in item 10 of the Financing Statement Addendum (Form UCC1Ad) <br />2a. ORGANIZATION'S NAME <br />OR <br />2b. INDIVIDUAL'S SURNAME <br />FIRST PERSONAL NAME <br />ADDITIONAL NAME(S)/INITIAL(S) <br />SUFFIX <br />2c. <br />MAILING ADDRESS <br />CITY <br />STATE <br />POSTAL CODE <br />COUNTRY <br />3. SECURED PARTY'S NAME (or NAME of ASSIGNEE of ASSIGNOR SECURED PARTY): Provide only gm Secured Party name (3a or 3b) <br />3a. ORGANIZATION'S NAME DIVERSIFIED FINANCIAL SERVICES, LLC <br />OR <br />3b. INDIVIDUAL'S SURNAME <br />FIRST PERSONAL NAME <br />ADDITIONAL NAME(S)/INITIAL(S) <br />SUFFIX <br />3c. MAILING ADDRESS 14010 FNB PARKWAY STE 400 <br />CITY <br />OMAHA <br />STATE <br />NE <br />POSTAL CODE <br />68154 <br />COUNTRY <br />USA <br />- 4.1 RIM0 Saf3fLsli5NiVALLY1PiVerl'OWER 1250' <br />5. Check oily if applicable and check only one box: Collateral is El held in a Trust (see UCC1Ad, item 17 and Instructions) being administered by a Decedent's Personal Representative <br />6a. Check only if applicable and check only one box: 6b. Check only if applicable and check only one box: <br />0 Public -Finance Transaction El Manufactured -Home Transaction 0 A Debtor is a Transmitting Utility El Agricultural Lien 0 Non -UCC Filing <br />7. ALTERNATIVE DESIGNATION (if applicable): 0 Lessee/Lessor El Consignee/Consignor 0 Seller/Buyer 0 Bailee/Bailor 0 Licensee/Licensor <br />8. OPTIONAL FILER REFERENCE DATA: :218278-001 <br />2036 38576 <br />FILING OFFICE COPY — UCC FINANCING STATEMENT (Form UCC1) (Rev. 04/20/11) <br />5o <br />