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202403477
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Last modified
7/25/2024 12:09:19 PM
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7/25/2024 12:09:18 PM
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202403477
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1 <br />UCC FINANCING STATEMENT ADDENDUM <br />FOLLOW INSTRUCTIONS <br />9. NAME OF FIRST DEBTOR: Same as line 18 or 1b on Financing Statement if line 1b was left blank <br />because Individual Debtor name did not fit, check here <br />OR <br />9a. ORGANIZATION'S NAME <br />9b. INDIVIDUAL'S SURNAME <br />Lewis <br />FIRST PERSONAL NAME <br />Ruth <br />ADDITIONAL NAME(S)/INITIAL(S) <br />SUFFIX <br />202403477 <br />THE ABOVE SPACE IS FOR FILING OFFICE USE ONLY <br />10. DEBTOR'S NAME: Provide (10a or 10b) only gna additional Debtor name or Debtor name that did not fit in line lb or 2b of the Financing Statement (Form UCC1) (use exact, full name; <br />do not omit, modify, or abbreviate any part of the Debtor's name) and enter the mailing address in line 10c <br />OR <br />10a. ORGANIZATIONS NAME <br />10b. INDIVIDUAL'S SURNAME <br />INDIVIDUAL'S FIRST PERSONAL NAME <br />12. ADDITIONAL SPACE FOR ITEM 4 (Collateral): <br />13. [DJ This FINANCING STATEMENT is to be filed [for record] (or recorded) in the <br />REAL ESTATE RECORDS (if applicable) <br />14. This FINANCING STATEMENT: <br />covers timber to be cut El covers as -extracted collateral ® is filed as a fixture filing <br />15. Name and address of a RECORD OWNER of real estate described in item 16 <br />(if Debtor does not have a record interest): <br />Ruth Lewis <br />16. Description of real estate: <br />County of: Hall <br />Address: 327 QUAIL CT, DONIPHAN, NE, 68832 <br />APN: 400385791 <br />SOUTH PLATTE TWP AMICK ACRES WEST SUB LT47; MAP <br />NUMBER: 3566-00-0-00065-000-0047 <br />17. MISCELLANEOUS: <br />FILING OFFICE COPY — UCC FINANCING STATEMENT ADDENDUM (Form UCC1Ad) (Rev. 07/01/23) <br />INDIVIDUAL'S ADDITIONAL NAME(S)/INITIAL(S) <br />SUFFIX <br />10c. MAILING ADDRESS <br />CITY <br />STATE <br />POSTAL CODE <br />COUNTRY <br />11. <br />OR <br />Q ADDITIONAL SECURED PARTY'S NAME su ASSIGNOR SECURED PARTY'S NAME: Provide only gag name (11a or 11b) <br />11a. ORGANIZATION'S NAME <br />11b. INDIVIDUAL'S SURNAME <br />FIRST PERSONAL NAME <br />ADDITIONAL NAMES)/INITIAL(S) <br />SUFFIX <br />11c. MAILING ADDRESS <br />CITY <br />STATE <br />POSTAL CODE <br />COUNTRY <br />12. ADDITIONAL SPACE FOR ITEM 4 (Collateral): <br />13. [DJ This FINANCING STATEMENT is to be filed [for record] (or recorded) in the <br />REAL ESTATE RECORDS (if applicable) <br />14. This FINANCING STATEMENT: <br />covers timber to be cut El covers as -extracted collateral ® is filed as a fixture filing <br />15. Name and address of a RECORD OWNER of real estate described in item 16 <br />(if Debtor does not have a record interest): <br />Ruth Lewis <br />16. Description of real estate: <br />County of: Hall <br />Address: 327 QUAIL CT, DONIPHAN, NE, 68832 <br />APN: 400385791 <br />SOUTH PLATTE TWP AMICK ACRES WEST SUB LT47; MAP <br />NUMBER: 3566-00-0-00065-000-0047 <br />17. MISCELLANEOUS: <br />FILING OFFICE COPY — UCC FINANCING STATEMENT ADDENDUM (Form UCC1Ad) (Rev. 07/01/23) <br />
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