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202200166 5. IN WITNESS WHEREOF, Mortgagee has executed this Agreement by signing on the (a) 4{-(n, day of (b) > M„r, (c) 20 BY (d) TITLE (e) � 0 - 4 6. ACKNOWLEDGMENT STATE 07 NEBug�S ) COUNTY OF i" Izi / ) /A This foregoing instrument was�/acknowledged before methisday of 202& by �L.Jili11 ck Zir�-I h� (Du y ut.orized Officer) \✓tLiVLLi(.(I CL of 'Fa-VC" Cr4G1 �7YV\CLS � 2�/(Cixt f L' -A (Tit'. My commission expires: CRYSTAL STUTZMAN General Notary - State of Nebraska My Commission Expires Jan 31, 2023 NOTE: The following statement is made in accordance with the Privacy Act of 1974 (5 U.S.C. 552a - as amended). The authority for requesting the information identified on this form is the Consolidated Farm and Rural Development Act, as amended (7 U.S.C. 1921 /. sea.). The information will be used to determine eligibility and feasibility for loans and loan guarantees, and servicing of loans and loan guarantees. The information collected on this fours may be disclosed to other Federal, State, and local government agencies, Tribal agencies, and nongovernmental entities that have been authorized access to the information by statute or regulation andior as described In the applicable Routine Uses identified In the System of Records Notice for USDA/FSA-14, Applicant/Borrower. Providing the requested information is voluntary. However, failure to furnish the requested information may result in a denial for loans and loan guarantees, and servicing of loans and loan guarantees. The provisions of criminal and civil fraud, privacy, and other statutes maybe applicable to the information provided. According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, end a person is not required to respond to, a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0560-0237. The time required to complete this information collection is estimated to average 30 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. RETURN THIS COMPLETED FORM TO YOUR COUNTY FSA OFFICE. The U.S. Department of Agriculture (USDA) prohibits discrimination in all Its programs and activities on the basis otrace. color, national origin, age, disability, and where applicable, sax, marital status, familial status, parental status. religion, sexual orientation, genetic information, political beliefs, reprisal, or because all or part atm individual's income is derived from any public assistance program. (Not all prohibited bases apply to all programs.) Persons with disabilities who require alternative means for communication of program information (Braille, large print, audlotape, etc.) should contact USDA's TARGET Center at (202) 720- 2600 (voice 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 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 (English Federal -relay) or (800) 845-6136 (Spanish Federal -relay). USDA is an equal opportunity provider and employer. FSA -231 9 (01-11-12) Page 2 oft