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1 � p (� <br /> (Check applicable box(es)J s7 a7 10 6 4 7 '7 <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] <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 /> Borrower �eodore R. Shafer <br /> (Sefll) <br /> Borrower g,�rla Shafer <br /> (Seal) <br /> Borrower <br /> ($@81� <br /> Borrower <br /> [Space Below Thls Llne For Acknowledgment� <br /> STATE OF Nebraska <br /> � ss: <br /> COUNTY OF Dawson , <br /> I, Edgar A. Rikli , a Notary Public in and for said county and state, do hereby <br /> certiry that Theodore R. Shafer and Karla Shafer, Husband and Wife <br /> personally appeared before me and is (are) known to me to be the person(s) who, being fnEormed of the contents of the toregoing <br /> instrument, have executed same, and acknowledged said instrument to be their , free and voluntary act and deed <br /> le, her, t slr <br /> and that they executed said instrument for the purposes an� uses t�ie�ein set forth. <br /> (he, ehe, thsy) <br /> Witness my hand and oificial seal this 25th day of June 1999 . <br /> My Commission Expires: ��� <br /> ��,�,~ " D�G�' �� I�����'v� SEAL <br /> This instrument was prepared by: <br /> Form 3028 9/BO <br /> Ft029.1MO (10/97) Page 5 0l 5 <br />