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200110742 <br />UCC FINANCING STATEMENT <br />FOLLOW INSTRUCTIONS front and back CAREFULLY <br />A. NAME 8 PHONE OF CONTACT AT FILER [optional] <br />B. SEND ACKNOWLEDGEMENT TO: (Name and Address) <br />Farmers State Bank <br />2nd and Vine <br />P. 0. Box 246 <br />Silver Creek, NE 68663 -0246 <br />ITHE ABOVE SPACE IS FOR FILING OFFICE USE ONLY <br />1. DEBTOR'S EXACT FULL LEGAL NAME - insert only one debtor name (la or lb) - do not abbreviate or combine names <br />1a. ORGANIZATION'S NAME <br />OR 1 b. INDIVIDUAL'S LAST NAME FIRST NAME MIDDLE NAME SUFFIX <br />Gonzalez Mauricio A. <br />1c. MAILING ADDRESS CITY STATE POSTAL CODE COUNTRY <br />807 West Division Grand Island NE 68801 USA <br />1 d. TAX ID #: SSN OR EIN ADD'L INFO RE Ile. TYPE OF ORGANIZATION 1f. JURISDICTION OF ORGANIZATION 1 g. ORGANIZATIONAL ID #, if any <br />560-97 -2419 ORGANIZATION DEBTOR I Individual <br />NC <br />2. ADDITIONAL DEBTOR'S EXACT FULL LEGAL NAME - insert only one debtor name (2a or 21b) - do not abbreviate or combine names <br />2a. ORGANIZATION'S NAME <br />OR 2b. INDIVIDUAL'S LAST NAME FIRST NAME MIDDLE NAME SUFFIX <br />Gonzalez Carmen <br />2c. MAILING ADDRESS CITY STATE POSTAL CODE COUNTRY <br />807 West Division Grand Island NE 168801 USA <br />2d. TAX ID #: SSN OR EIN ADD'L INFO RE 12e. TYPE OF ORGANIZATION 2f. JURISDICTION OF ORGANIZATION 2g. ORGANIZATIONAL ID #, if any <br />ORGANIZATION Individual <br />DEBTOR <br />NC <br />3. SECURED PARTY'S NAME (or NAME of TOTAL ASSIGNEE of ASSIGNOR S /P) - insert only one secured party name (3a or 3b) <br />3a. ORGANIZATION'S NAME <br />Farmers State Bank <br />OR 31b. INDIVIDUAL'S LAST NAME FIRST NAME MIDDLE NAME SUFFIX <br />3c. MAILING ADDRESS CITY STATE I POSTAL CODE COUNTRY <br />2nd and Vine, P. 0. BOX 246 Silver Creek NE 68663 -0246 <br />4. This FINANCING STATEMENT covers the following collateral: <br />All Inventory, Chattel Paper, Accounts, Equipment, General Intangibles and Fixtures; whether any of the foregoing is owned now or <br />acquired later; all accessions, additions, replacements, and substitutions relating to any of the foregoing; all records of any kind relating to <br />any of the foregoing; all proceeds relating to any of the foregoing (including insurance, general intangibles and other accounts proceeds) <br />g This FINANCING STATEMENT is to be filed [for record] (or recorded) in the REAL 7 Check to REQUEST SEARCH REPORTS) on Debtors) _, CORD h Ad d li I A F n All Debtors Debtor 1 Debtor 2 <br />8. OPTIONAL FILER REFERENCE DATA <br />Harland Financial Solutions <br />FILING OFFICE COPY — NATIONAL UCC FINANCING STATEMENT (FORM UCC1) (REV. 07/29/98) 400 S.W. 6th Avenue, Portland, Oregon 97204 <br />