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202100136
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1/7/2021 11:13:35 AM
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1/7/2021 11:13:35 AM
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202100136
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UCC FINANCING STATEMENT ADDENDUM <br />FOLLOW INSTRUCTIONS <br />9. NAME OF FIRST DEBTOR: Same as line la or lb on Financing Statement; if line lb was left blank <br />because Individual Debtor name did not fit, check here <br />OR <br />9a. ORGANIZATION'S NAME <br />• <br />9b. INDIVIDUALS SURNAME <br />DIBBERN <br />FIRST PERSONAL NAME <br />JERRY <br />R <br />ADDITIONAL NAME(S)/INITIAL(S) <br />SUFFIX <br />202100136 <br />THE ABOVE SPACE IS FOR FILING OFFICE USE ONLY <br />10. DEBTOR'S NAME: Provide (10a or 10b) only = additional Debtor name or Debtor name that did not fit in line lb or 2b of the Financing Statement (Form UCC1) (use exact, full name; <br />do not omit, modify, or abbreviate any part of the Debtors name) and enter the mailing address in line 10c <br />10a. ORGANIZATION'S NAME <br />OR <br />10b. INDIVIDUAL'S SURNAME <br />INDIVIDUAL'S FIRST PERSONAL NAME <br />INDIVIDUAL'S ADDITIONAL NAME(S)/INITIAL(S) <br />SUFFIX <br />10c. MAILING ADDRESS <br />CITY <br />STATE <br />POSTAL CODE <br />COUNTRY <br />11. <br />OR <br />U ADDITIONAL SECURED PARTY'S NAME <br />QC <br />• <br />ASSIGNOR SECURED PARTY'S NAME: Provide only one name (11a or 11b) <br />11a. ORGANIZATION'S NAME <br />11 b. 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 />13. FZI 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 GZI is filed as a fixture filing <br />15. Name and address of a RECORD OWNER of real estate described in item 16 <br />VEiRNA Fe& JERRYcR DIBBERN <br />16. Description of real estate: <br />JACKSON TWP PT E 3/4 OF N 1/2 NW 1/4 56.48 AC SEC <br />2-T1O-R12, HALL COUNTY, NE <br />17. MISCELLANEOUS: <br />FILING OFFICE COPY — UCC FINANCING STATEMENT ADDENDUM (Form UCC1Ad) (Rev. 04/20/11) <br />
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