Laserfiche WebLink
UCC FINANCING STATEMENT ADDENDUM <br />200405979 <br />FOLLOW INSTRUCTIONS (front and back) CAREFULLY <br />9. NAME OF FIRST DEBTOR 0a or 1b) ON RELATED FINANCING STATEMENT <br />9a. ORGANIZATION'S NAME <br />OR <br />9b. INDIVIDUAL'S LAST NAME FIRST NAME MIDDLE NAME,SUFFIX <br />HORST RONALD ID <br />10. MISCELLANEOUS: <br />' THE ABOVE SPACE IS FOR FILING OFFICE USE ONLY <br />11 AnnITInNAI EXACT FULL LEGAL NAME - Insert only one name (11a or 11 b) - do not abbreviate or combine names <br />13. This FINANCING STATEMENT covers ❑ timber to be cut or ❑ as- extracted 16. Additional collateral description <br />collateral, or is filed as a ® fixture filing. <br />14. Description of real estate: <br />See attached Exhibit "All <br />15. Name and address of a RECORD OWNER of above - described real estate <br />(if Debtor does not have a record interest): <br />17. Check only if applicable and check only one box. <br />Debtor is a ❑ Trust or ❑ Trustee acting with respect to property held in trust or ❑ Decedent's Estate <br />18. Check 2 =1 if applicable and check 2=1 one box. <br />❑ Debtor is a TRANSMITTING UTILITY <br />❑ Filed in connection with a Manufactured -Home Transaction -- effective 30 years <br />❑ Filed in connection with a Public - Finance Transaction -- effective 30 years <br />FILING OFFICE COPY -- NATIONAL UCC FINANCING STATEMENT ADDENDUM (FORM UCC1Ad) (REV. 07/29/98) Bankers Systems, Inc., St. Cloud, MN Form UCC- IADD -LAZ 5/30/2001 <br />11 a. ORGANIZATION'S NAML <br />OR <br />11b. INDIVIDUAL'S LAST NAME <br />FIRST NAME <br />MIDDLE NAME <br />SUFFIX <br />HORST <br />BERNARD <br />E <br />11c. MAILING ADDRESS <br />CITY <br />STATE <br />POSTAL CODE <br />COUNTRY <br />1726 LARIAT LANE <br />GRAND ISLAND <br />NE <br />168803 <br />USA <br />11d. TAX ID A: SSN OR EIN <br />Ille. TYPE OF ORGANIZATION 11f. JURISDICTION OF ORGANIZATION 11g. ORGANIZATIONAL ID #, if any <br />JADD'ILINFORE <br />ORGANIZATION <br />DEBTOR ❑ NONE <br />12. <br />ADDITIONAL SECURED PARTY'S or ASSIGNOR S /P'S NAME - insert only one name (12a or 12b) <br />12a. ORGANIZATION'S NAME <br />OR <br />12b. INDIVIDUAL'S LAST NAME <br />FIRST NAME <br />MIDDLE NAME <br />SUFFIX <br />12c. MAILING ADDRESS <br />ICITY <br />STATE <br />POSTAL CODE <br />COUNTRY <br />13. This FINANCING STATEMENT covers ❑ timber to be cut or ❑ as- extracted 16. Additional collateral description <br />collateral, or is filed as a ® fixture filing. <br />14. Description of real estate: <br />See attached Exhibit "All <br />15. Name and address of a RECORD OWNER of above - described real estate <br />(if Debtor does not have a record interest): <br />17. Check only if applicable and check only one box. <br />Debtor is a ❑ Trust or ❑ Trustee acting with respect to property held in trust or ❑ Decedent's Estate <br />18. Check 2 =1 if applicable and check 2=1 one box. <br />❑ Debtor is a TRANSMITTING UTILITY <br />❑ Filed in connection with a Manufactured -Home Transaction -- effective 30 years <br />❑ Filed in connection with a Public - Finance Transaction -- effective 30 years <br />FILING OFFICE COPY -- NATIONAL UCC FINANCING STATEMENT ADDENDUM (FORM UCC1Ad) (REV. 07/29/98) Bankers Systems, Inc., St. Cloud, MN Form UCC- IADD -LAZ 5/30/2001 <br />