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0001 446 <br />[Check applicable box(es)] <br />❑ Adjustable Rate Rider ❑ Condominium Rider ❑ 1 -4 Family Rider <br />❑ Graduated Payment Rider ❑ Planned Unit Development Rider ❑ Biweekly Payment Rider <br />❑ Balloon Rider ❑ Rate Improvement Rider ❑ Second Home Rider <br />© Other(s) [Specify] Assignment of Rents Rider <br />BY SIGNING BELOW, Borrower accepts and agrees to the terms and covenants contained in this Security Instrument and in any <br />rider(s) executed by Borrower and recorded with it. <br />Witnesses: <br />STATE OF Nebraska <br />COUNTY OF Hall <br />(Seal) <br />Borrows Russ II A. KUM <br />Gtiie4—' (Seal) <br />Borrower Andrea M. J t bson <br />(Seal) <br />Borrower <br />(Seal) <br />Borrower <br />[Space Below This Line For Acknowledgment] <br />ss: <br />I, William L McLellan , a Notary Public in and for said county and state, do hereby <br />certify that Andrea M. Jacobson , both as unmarried individuals <br />personally appeared before me and is (are) known to me to be the person(s) who, being informed of the contents of the foregoing <br />instrument, have executed same, and acknowledged said instrument to be their h r1 , free and voluntary act and deed <br />and that they executed said instrument for the purposes anfd� uses therein set forth. <br />(he, she, they) <br />Witness my hand and official seal this 29th day of November 2000 <br />My Commission Expires: <br />GENERAL NOTARY -State of Nebraska <br />WILLIAM L. McLELLAN <br />My Comm. Exp. Aug. 12, 2004 SEAL <br />William L McLellan <br />This instrument was prepared by: <br />eS i Al S. OF /iR1711i'M <br />,jt-'r Y OF fsil8ll,�P)Pr�i• <br />rMp thi <br />s, 2qlday of <br />tf�. d• ^��� r3 <br />ANDREA ZEPEDA <br />YAPo <br />coulla <br />4yConnt. Expiee 11-01004 <br />Ft 029.1- 1 <br />1d7a <br />Page 5 of 5 <br />Form 3028 9/90 <br />