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202101819
<br />5. IN WITNESS WHEREOF, Mortgagee has executed this Agreement by signing on the (a) day
<br />of (b) lv , (c) 20A).
<br />BY (d)
<br />TITLE (e) Ory�w4,14vv14-'/ 404k1_ Ps
<br />STATE OF NEBRASKA
<br />COUNTY OF
<br />6. ACKNOWLEDGMENT
<br />This foregoing instrument was acknowled d befo e this *..t +�
<br />l
<br />0C-1-0•31.-14-2020, by ` 1
<br />day of
<br />rr ((Duly Authorize • Officer)
<br />�I
<br />1.0V11011‘141. ett,VC ereSi(Je1/J of t bccA- D1�� &tVLic
<br />1
<br />(Title)
<br />My commission expires:
<br />1h�1' GENERAL
<br />SE PAUNOL E SULLIVAN NebraskaY - State of
<br />My Comm. Exp. April 28, 2021
<br />(Name of Mortgagee)
<br />General Notary
<br />NOTE: The following statement is made in accordance with the Privacy Act of 1974 (5 U.S.C. 552a - as amended). The authority for
<br />requesting the information identified on this form is the Consolidated Farm and Rural Development Act, as amended (7 U.S.C. 1921
<br />et. seq.). The information will be used to determine eligibility and feasibility for loans and loan guarantees, and servicing of loans and
<br />loan guarantees. The information collected on this form may be disclosed to other Federal, State, and local government agencies,
<br />Tribal agencies, and nongovernmental entities that have been authorized access to the information by statute or regulation and/or as
<br />described in the applicable Routine Uses identified in the System of Records Notice for USDA/FSA-14, Applicant/Borrower.
<br />Providing the requested information is voluntary. However, failure to furnish the requested information may result in a denial for
<br />loans and loan guarantees, and servicing of loans and loan guarantees. The provisions of criminal and civil fraud, privacy, and other
<br />statutes may be applicable to the information provided.
<br />According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond
<br />to, a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information
<br />collection is 0560-0237. The time required to complete this information collection is estimated to average 30 minutes per response,
<br />including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and
<br />completing and reviewing the collection of information. RETURN THIS COMPLETED FORM TO YOUR COUNTY FSA OFFICE.
<br />The U.S. Department of Agriculture (USDA) prohibits discrimination in all its programs and activities on the basis of race, color, national origin, age, disability, and
<br />where applicable, sex, marital status, familial status, parental status, religion, sexual orientation, genetic information, political beliefs, reprisal, or because all or part
<br />of an individual's income is derived from any public assistance program. (Not all prohibited bases apply to all programs.) Persons with disabilities who require
<br />alternative means for communication of program information (Braille, large print, audiotape, etc.) should contact USDA's TARGET Center at (202) 720-2600 (voice
<br />and TDD). To file a complaint of discrimination, write to USDA, Assistant Secretary for Civil Rights, Office of the Assistant Secretary for Civil Rights, 1400
<br />Independence Avenue, S. W., Stop 9410, Washington, DC 20250-9410, or call toll-free at (866) 632-9992 (English) or (800) 877-8339 (TDD) or (866) 377-8642
<br />(English Federal -relay) or (800) 845-6136 (Spanish Federal -relay). USDA is an equal opportunity provider and employer.
<br />FSA -2319 (01-11-12) Page 2 of 2
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