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Name and address of Beneficiary: 200110847 <br />Herbert and Helen Koch <br />5300 N. North Road <br />Grand Island, NE 68803 <br />STATE OF NEBRASKA <br />SS: <br />COUNTY OF HALL <br />he foregoing instrument was acknowledged before me on <br />16 / SCI , 2001, by Dag Ben g Ake Hellsten and Pamela J. <br />Hellsten, husband and wife. / :' <br />Notar ublic <br />My commission expires: U!— Z V_67 GENERAL NOTARY -Stale 01 Nebraska <br />LAGHAN <br />�MY Comm. Exp. Sept. 28, 2003 <br />