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• <br />UCC FINANCING STATEMENT ADDENDUM <br />FOLLOW INSTRUCTIONS <br />9. NAME OF FIRST DEBTOR: Same as line la or 1b on Financing Statement; if line 1b was left blank <br />because Individual Debtor name did not fit, check here ❑ <br />OR <br />9a. ORGANIZATIONS NAME <br />9b. INDIVIDUALS SURNAME <br />DONALDSON <br />FIRST PERSONAL NAME <br />DORCAS <br />ADDITIONAL NAME(S)/INITIAL(S) <br />SUFFIX <br />202105583 <br />THE ABOVE SPACE IS FOR FILING OFFICE USE ONLY <br />10. DEBTOR'S NAME: Provide (10a or 10b) only one 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 Debtor's name) and enter the mailing address in line 10c <br />OR <br />10a. ORGANIZATIONS NAME <br />10b. INDIVIDUAL'S SURNAME <br />INDIVIDUALS FIRST PERSONAL NAME <br />INDIVIDUALS 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 />Ea ADDITIONAL SECURED PARTY'S NAME <br />or <br />• <br />ASSIGNOR SECURED PARTY'S NAME: Provide only one name (11a or 11b) <br />11a. ORGANIZATIONS 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 />412 JOHNSON DR <br />GRAND ISLAND, NE 68803-4127 <br />— THIS FILING IS MADE FOR NOTICE PURPOSES ONLY. THE DEBTOR HAS NO OWNERSHIP RIGHTS IN THE <br />COLLATERAL. THE DEBTOR IS LEASING THE COLLATERAL. <br />13. m 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 71 is filed as a fixture filing <br />15. Name and address of a RECORD OWNER of real estate desuibed in item 16 <br />DORCASeDONALDSSOiNerest>: <br />412 JOHNSON DR <br />GRAND ISLAND, NE 68803-4127 <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 412 JOHNSON DR, <br />GRAND ISLAND NE 68803-4127 CO29 CURRENTLY OWNED BY <br />DONALDSON DORCAS HAVING A TAX ASSESSOR NUMBER <br />OF 400142112 AND BEING THE SAME PROPERTY MORE <br />FULLY DESCRIBED AS WOLFE'S SUB LT 52 <br />APN: 400142112 <br />17. MISCELLANEOUS: <br />FILING OFFICE COPY — UCC FINANCING STATEMENT ADDENDUM (Form UCC1Ad) (Rev. 04/20/11) <br />