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202108197
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9/27/2021 11:37:45 AM
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9/27/2021 11:37:44 AM
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202108197
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• <br />UCC FINANCING STATEMENT ADDENDUM <br />FOLLOW INSTRUCTIONS <br />9. <br />OR <br />AME OF FIRST DEBTOR: Same as line la or lb on Financing Statement; if line 1b was left blank <br />ecause Individual Debtor name did not fit, check here 111 <br />9a. ORGANIZATION'S NAME <br />9b. INDIVIDUAL'S SURNAME <br />ULMER <br />FIRST PERSONAL NAME <br />EUGENE <br />V. <br />ADDITIONAL NAME(S)/INITIAL(S) <br />SUFFIX <br />202108197 <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. ORGANIZATION'S NAME <br />10b. INDIVIDUAL'S SURNAME <br />INDIVIDUAL'S FIRST PERSONAL NAME <br />12. ADDITIONAL SPACE FOR ITEM 4 (Collateral): <br />2204 W ANNA <br />GRAND ISLAND, NE 68803 <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. Z 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 />0 covers timber to be cut ❑ covers as -extracted collateral IZ is filed as a fixture filing <br />15. Name and address of a RECORD OWNER of real estate described in item 16 <br />EUGENEBV. oULMERrd'"tarsal): <br />2204 W ANNA <br />GRAND ISLAND, NE 68803 <br />16. Description of real estate: <br />ALL THAT LOT, PIECE OR PARCEL OF LAND, SITUATE IN THE <br />CITY OF GRAND ISLAND, COUNTY OF HALL, STATE OF <br />NEBRASKA, BEING KNOWN AND DESIGNATED AS LOT 9 & 10, <br />BLOCK 48 & 49, WASMERS 3RD ADD <br />Parcel Number: <br />400111039 <br />17. MISCELLANEOUS: <br />FILING OFFICE COPY — UCC FINANCING STATEMENT ADDENDUM (Form UCC1Ad) (Rev. 04/20/11) <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 />1111 ADDITIONAL SECURED PARTY'S NAME <br />QL <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 />2204 W ANNA <br />GRAND ISLAND, NE 68803 <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. Z 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 />0 covers timber to be cut ❑ covers as -extracted collateral IZ is filed as a fixture filing <br />15. Name and address of a RECORD OWNER of real estate described in item 16 <br />EUGENEBV. oULMERrd'"tarsal): <br />2204 W ANNA <br />GRAND ISLAND, NE 68803 <br />16. Description of real estate: <br />ALL THAT LOT, PIECE OR PARCEL OF LAND, SITUATE IN THE <br />CITY OF GRAND ISLAND, COUNTY OF HALL, STATE OF <br />NEBRASKA, BEING KNOWN AND DESIGNATED AS LOT 9 & 10, <br />BLOCK 48 & 49, WASMERS 3RD ADD <br />Parcel Number: <br />400111039 <br />17. MISCELLANEOUS: <br />FILING OFFICE COPY — UCC FINANCING STATEMENT ADDENDUM (Form UCC1Ad) (Rev. 04/20/11) <br />
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