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202105725
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Last modified
7/6/2021 12:08:05 PM
Creation date
7/6/2021 12:08:05 PM
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202105725
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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 LJ <br />OR <br />9a ORGANIZATION'S NAME <br />9b. INDIVIDUAL'S SURNAME <br />BLASE <br />FIRST PERSONAL NAME <br />ERIC <br />A <br />ADDITIONAL NAME(S)/INITIAL(S) <br />SUFFIX <br />202105725 <br />THE ABOVE SPACE IS FOR FILING OFFICE USE ONLY <br />10. DEBTOR'S NAME: Provide (10a or 10b) only gag additional Debtor name or Debtor name that did not fit in line 1b 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 />10a. ORGANIZATION'S NAME <br />VK <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 />1.1 ADDITIONAL SECURED PARTY'S NAME <br />4t <br />• <br />ASSIGNOR SECURED PARTY'S NAME: Provide only ng name (11a or 11b) <br />11a. ORGANIZATIONS 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 />2819 IDAHO AVE <br />— GRAND ISLAND, NE 68803-1154 THIS FILING IS MADE FOR NOTICE PURPOSES ONLY. THE DEBTOR HAS NO <br />OWNERSHIP RIGHTS IN THE COLLATERAL. THE DEBTOR IS LEASING THE <br />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 is filed as a fixture filing <br />15. Name and address of a RECORD OWNER of real estate described in item 16 <br />ERICbA BBLs not ASEVe a record interest): <br />2819 IDAHO AVE <br />GRAND ISLAND, NE 68803-1154 <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 2819 IDAHO AVE, <br />GRAND ISLAND NE 68803-1154 CO22 CURRENTLY OWNED BY <br />BLASE ERIC A HAVING A TAX ASSESSOR NUMBER OF <br />400429241 AND BEING THE SAME PROPERTY MORE FULLY <br />DESCRIBED AS WOODLAND PARK FOURTH SUB LT 2 BLK 4; <br />MAP NUMBER:3315-00-0-16258-004-0002 <br />APN: 400429241 <br />17. MISCELLANEOUS: <br />FILING OFFICE COPY — UCC FINANCING STATEMENT ADDENDUM (Form UCC1Ad) (Rev. 04/20/11) <br />
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