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[Check applicable box(es)] <br />200010770 <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 />(Seal) <br />Sorr w urt M Bla <br />(Seal) <br />Bor ow r Renee N Blase <br />(Seal) <br />Borrower <br />(Seal) <br />Borrower <br />[Space Below This Line For Acknowledgmentl <br />STATE OF Nebraska <br />} <br />COUNTY OF Hall / ss: <br />I, , a Notary Public in and for said county and state, do hereby <br />certify that Kurt M Blase and Renee N Blase husband and wife <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 free and voluntary act and deed <br />Is, her, t eir <br />and that they executed said instrument for the purposes A uses t e ein set forth. <br />(he, she, they) <br />Witness my hand and official seal this 8th day of December 2000 <br />My Commission Expires: <br />GENERAL NOTARY-State of Nebras <br />SHERRI L. O'CALLAGHA <br />My Comm. EXP. Sept. 28. 2003 <br />This instrument was prepared by: <br />Form 3028 9/90 <br />F10291Mo (10/99) Page 5 of 5 <br />