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Last modified
1/25/2021 10:44:19 AM
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1/25/2021 10:44:19 AM
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202100633
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EXHIBIT A <br />-rt <br />n <br />r=nD� <br />= to <br />=INANCING STATEMENT <br />INSTRUCTIONS <br />& PHONE OF CONTACT AT FILER (optional) <br />1-800-858-5294 <br />L CONTACT AT FILER (optional) <br />:Fling@cscglobal.com <br />ACKNOWLEDGMENT TO: (Name and Address) <br />48938 <br />CSC P 0 • Ri5 g2 -CI &GI <br />Springfield, IL 62702 - 24q(e4 <br />L <br />Filed In: Nebraska <br />(Hall <br />n= <br />292400633 1'. <br />z <br />co <br />r,-, .......1 <br />d <br />c fir <br />V J I 73 <br />= c :-- rr-i <br />CD <br />z\ r'' 2 —1• -1-I rn N •b <br />- a, o -rI Iv to <br />F-+ <br />m ^ =m • tJ <br />D Q <br />O -ii 1'— 7J —I_�Q 1—s 1--- )Cf) <br />CO C <br />� <br />rri • r ' co7 �-- il'*7. ' <br />0 0) ,,, Z <br />N .-1 <br />THE ABOVE SPACE IS FOR FILING OFFICE USE ONLY <br />1. DEBTORS NAME: Provide only ma Debtor name (la or lb) (use exact, full name; do not omit, modify. or abbreviate any part of the Debtor's name); it'any part of the Individual Debtors <br />name will not fit in line lb, leave all of item 1 blank, check here 0 and provide the individual Debtor information in item 10 of the Financing Statement Addendum (Form UCC1Ad) <br />OR <br />CP <br />la. ORGANIZATION'S NAME <br />1b. INDIVIDUAL'S SURNAME <br />QUINTANA <br />FIRST PERSONAL NAME <br />AGUEDO <br />ADDITIONAL NAME(S)/INITIAL(S) <br />SUFFIX <br />1c. MAIUNGADDRESS 311 W 5TH <br />CITY <br />GRAND ISLAND <br />STATE <br />NE <br />POSTAL CODE <br />68801 <br />COUNTRY <br />USA <br />2. DEBTORS NAME: Provide only gaff Debtor name (2a or 2b) (use exact, full name; do not omit, modify, or abbreviate any part of the Debtor's name); If any part of the Individual Debtor's <br />nann: will not fit In tine 2b, leave all of Item 2 dank check here ❑ and provide the Individual Debtor information in item 10 of the Financing Statement Addendum (Form UCC1Ad) <br />OR <br />2a. ORGANIZATION'S NAME <br />2b. INDIVIDUAL'S SURNAME <br />FIRST PERSONAL NAME <br />ADDITIONAL NAME(S)ANITIAL(S) <br />SUFFIX <br />2a 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 one Secured Party name (3a or 3b) <br />3a. ORGANIZATIONS NAMEService Experts Heating & Air Conditioning LLC <br />OR <br />3b. INDIVIDUAL'S SURNAME <br />FIRST PERSONAL NAME <br />ADDITIONAL NAME(S)IINmAL(S) <br />SUFFIX <br />3c. MAILING ADDRESS 807 Claude Road <br />CITY <br />Grand Island <br />STATE <br />NE <br />POSTAL CODE <br />68803 <br />COUNTRY <br />USA <br />4 RA(,: Thi ftnend fl s lament covers are tolknr coil <br />he owing �escni)e� property as sego In that certain HVAC RENTAL AGREEMENT dated 05/13/2019, by and <br />between Service Experts Heating & Air Conditioning LLC and the Debtor. A ALLIED AIR heating component, Model <br />#A80UH1 D070Al2 (Serial # 1719B05939) and a ALLIED AIR air conditioner, Model # 4SCU13LE130P-5 (Serial # <br />1618K26058), whether now owned or hereafter acquired, together with all replacements thereof, all attachments, <br />accessories, parts <br />and tools belonging thereto or for use in connection therewith; and any and all products and proceeds of any of the <br />foregoing (including, but not limited to, any daims to any items referred to in thls definition, and any claims of Debtor <br />against third parties for loss of, damage to or destruction of any or all of the collateral or for proceeds payable under, or <br />unearned premiums with respect to, policies of insurance) in whatever form, including, but not limited to, all cash, <br />interest, principal, royalties, license fees, rents, dividends, negotiable instruments and other instruments for the payment <br />of money, chattel paper, security agreements and other documents or other property from time to time received, <br />receivable or otherwise distributed in respect of, or in exchange for, the collateral. Said collateral is located at address: <br />5. Check onlx if applicable and check only one bore Collateral Is ❑ held in a Trust (see UCC1Ad, Item 17 end Instructions) 0 being administered by a Decedents Personal Representative <br />6a. Check say if applicable end check MIX one bore 6b. Check ash If applicable and check erly one boot <br />0 Public -Finance Transaction 0 Manufactured -Home Transaction 0 A Debtor Is a Transmitting Utility 0 Agricultural Uen 0 Non -UCC Filing <br />7. ALTERNATIVE DESIGNATION Of epptleable): ❑ Lessee/Lessor 0 Consignee/Consignor 0 Seller/Buyer 0 Bailee/Belot 0 Licensee/Licensor <br />8. OPTIONAL FILER REFERENCE DATA: <br />2023 48938 <br />FILING OFFICE COPY — UCC FINANCING STATEMENT (Form UCC1) (Rev. 04/20/11) <br />
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