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202202366
<br />5. IN WITNESS WHEREOF, Mortgagee has executed this Agreement by signing on the (a) ( O+1'\ day
<br />of (b) Nca r , (c) 20,r 21
<br />BY (d)
<br />TITLE (e)
<br />1, CG
<br />/ 2.4_cfd(-/ i
<br />Grey A,5
<br />STATE OF NEB KA
<br />COUNTY OF
<br />This foregoing instrument
<br />\) ly Authorized Officer)
<br />V �' ���'���'
<br />(Title) (Name of Mortgagee)
<br />2022, by
<br />6. ACKNOWLEDGMENT
<br />was acknowledged before me this
<br />day of
<br />My commission expires:
<br />of
<br />GENERAL NOTARY - State of Nebraska
<br />DIVA A PRICE
<br />My Comm. E. December 20, 2024
<br />VAU
<br />eneral Notary
<br />.ina el • rr;cc.
<br />NOTE: The following statement is made In accordance with the Privacy Act of 1974 (5 U.S.C. 5528 - as amended). The authority for
<br />requesting the information identified on this form is the Consolidated Farm and Rural Development Act, as amended (7 U.S.C.
<br />1921 at. sea.). The information will be used to determine eligibility and feasibility for loans and loan guarantees, and servicing of
<br />loans and loan guarantees. The information collected on this form may be disclosed to other Federal, State, and local government
<br />agencies, Tribal agencies, and nongovemmental entities that have been authorized access to the information by statute or
<br />regulation and/or as described in the epplicable Routine Uses identified in the System of Records Notice for USDA/FSA-14,
<br />Applicant/Borrower. Providing the requested information is voluntary. However, failure to furnish the requested information may
<br />result in a denial for loans and loan guarantees, and servicing of loans and loan guarantees. The provisions of criminal and civil
<br />fraud, privacy, and other statutes may be applicable to the information provided.
<br />According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to
<br />respond to, a collection of information unless it displays a valid OMB control number The valid OMB control number for this
<br />information collection is 0560-0237. The time required to complete this information collection is estimated to average 30 minutes
<br />per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data
<br />needed, and completing and reviewing the collection of information. RETURN THIS COMPLETED FORM TO YOUR COUNTY
<br />FSA OFFICE.
<br />The U.S. Department of Agriculture (USDA) prohibits discrimination in ell its programs and activities on the basis of race, color, national origin, age, disability, and
<br />where applicable, sex, marital status, familial status, parental status, religion, sexual orientation, genetic information, political beliefs, reprisal, or because all or
<br />part of an indviduars income is derived from any public assistance program. (Not all prohibited bases apply to all programs.) Persons with dsablliles who
<br />require alternative means for communication of program Information (Braille, large print, audiotape, etc.) should contact USDA's TARGET Center et (202) 720-
<br />2600 (voice and TDD). To file a complaint of discrimination, write to USDA, Assistant Secretary for CMI Rights, Office of the Assistant Secretary for Civil Rights,
<br />1400 Independence Avenue, S. W., Stop 9410, Washington, DC 20250.9410, or call toil -free at (866) 632-9992 (English) or (800) 877-8339 (TDD) or (866) 377-
<br />8642 (English Federal -relay) or (800) 845-6136 (Spanish Federal -relay). USDA is an equal opportunity provider and employer.
<br />FSA -2319 (01-11-12) Page 2 of 2
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