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200400619 <br />STATE OF NEBRASKA, HALL County ss: <br />The foregoing instrument was acknowledged before me this 15TH day of <br />JANUARY, 2004 by KEITH A JORGENSEN AND RITA K JORGENSEN, HUSBAND <br />AND WIFE, <br />Witness my hand and notarial seal at <br />the date aforesaid. <br />My Commission Expires: <br />JA <br />I GENERAL NOTARY -Stale of Nebraska <br />KATHLEEN A. SCHLACHTER <br />My Comm. Up. May 21, 2004 <br />=k- 6(NE) (0005) <br />GRAND ISLAND, NEBRASKA in said County, <br />r <br />Notary ublic <br />Page 15 of 15 <br />Initials: <br />229633 <br />Form 3028 1/01 <br />