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UCC FINANCING STATEMENT ADDENDUM <br />FOLLOW INSTRUCTIONS <br />9. NAME <br />because <br />OR <br />OF FIRST DEBTOR: Same as line la or 1b on Financing Statement; if line lb was left blank <br />Individual Debtor name did not fit, check here <br />9a. ORGANIZATION'S NAME <br />9b. INDIVIDUAL'S SURNAME <br />HENRY <br />FIRST PERSONAL NAME <br />MANDY <br />ADDITIONAL NAME(S)/INITIAL(S) <br />KAYE <br />SUFFIX <br />20210'7394 <br />THE ABOVE SPACE IS FOR FILING OFFICE USE ONLY <br />10. DEBTORS NAME: Provide (10a or 10b) only one 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. ORGANIZATIONS NAME <br />UK <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 />111 ADDITIONAL SECURED PARTY'S NAME <br />9i <br />• <br />ASSIGNOR SECURED PARTY'S NAME: Provide only one name (11a or 11b) <br />11a. ORGANIZATION'S 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 />907 CLAUSSEN AVE <br />- GRAND ISLAND, NE 68801-8038 THIS FILING IS MADE FOR NOTICE PURPOSES ONLY. THE DEBTOR HAS NO <br />OWNERSHIP RIGHTS IN THE 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 (] is filed as a fixture filing <br />15. Name and address of a RECORD OWNER of real estate described in item 16 <br />MANDY KAY HENrRY interest): <br />907 CLAUSSEN AVE <br />GRAND ISLAND, NE 68801-8038 <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 907 CLAUSSEN AVE, <br />GRAND ISLAND NE 68801-8038 C016 CURRENTLY OWNED BY <br />HENRY JAMIE GENE / HENRY MANDY KAYE HAVING A TAX <br />ASSESSOR NUMBER OF 400031795 AND BEING THE SAME <br />PROPERTY MORE FULLY DESCRIBED AS CLAUSSEN <br />COUNTRY VIEW ADD LT 15 BLK 5; MAP NUMBER: <br />3315-00-0-11185-005-0015 <br />APN: 400031795 <br />17. MISCELLANEOUS: <br />FILING OFFICE COPY— UCC FINANCING STATEMENT ADDENDUM (Form UCC1Ad) (Rev. 04/20/11) <br />