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M <br />3b. INDIVIDUAL'S LAST NAME <br />FIRST NAME <br />MIDDLE NAME <br />CITY <br />rn <br />= A <br />� <br />z <br />COUNTRY <br />3c. MAILING ADDRESS <br />200 W. JACKSON #720 <br />n = <br />IL <br />60606 <br />UCC FINANCING STATEMENT <br />FOLLOW INSTRUCTIONS (front and back) CAREFULLY <br />A. NAME & PHONE OF CONTACT AT FILER [optional] <br />Phone:(800) 331 -3282 Fax: (818) 662 -4141 <br />B. SEND CKNOWLEDGEMEN : (Name and Address) 510656 IPRIMEACCEPT <br />7 <br />cn <br />UCC Direct Services 6459310 c <br />P.O. Box 29071 <br />Glendale, CA 91209 -9071 N EN E <br />L FIXTURE <br />1. DEBTOR'S EXACT FULL LI <br />1a. ORGANIZATION'S NAME <br />(10 <br />o —a <br />C D <br />M <br />r �:o <br />17- <br />(f) <br />x <br />D <br />Cn <br />U) <br />File with: Hall County Register of Deeds, NE THE ABOVE SPACE IS FOR FILING OFFICE USE ONLY <br />�L NAME - insert only one debtor name (1 a or 1 b) - do not abbreviate or combine names <br />OR FIRST NAME MIDDLE NAME <br />1b. INDIVIDUAL'S LAST NAME <br />WERNER TAMARA <br />tc. MAILING ADDRESS CITY STATE I POSTAL CODE <br />518 E. 1ST ST. GRAND ISLAND NE 68801 <br />1d. SEE INSTRUCTIONS DD'L INFO RE 11e.TYPEOF ORGANIZATION 1f. JURISDICTION OF ORGANIZATION 1g. ORGANIZATIONAL ID #, if any <br />ORGANIZATION <br />DEBTOR <br />2. ADDITIONAL DEBTOR'S EXACT FULL LEGAL NAME - insert only one debtor name (2a or 2b) - do not abbreviate or combine names <br />2a. ORGANIZATION'S NAME <br />OR 2b. INDIVIDUAL'S LAST NAME I FIRST NAME I MIDDLE NAME <br />2c. MAILING ADDRESS CITY I STATE I POSTAL <br />2d. SEE INSTRUCTIONS DD'L INFO RE 2e. TYPE OF ORGANIZATION 2f. JURISDICTION OF ORGANIZATION 12g. ORGANIZATIONAL ID #, if any <br />ORGANIZATION <br />DEBTOR <br />3. SECURED PARTY'S NAME (or NAME of TOTAL ASSIGNEE of ASSIGNOR S /P) - insert only one secured party name (3a or 3b) <br />3a. ORGANIZATION'S NAME <br />PRIME ACCEPTANCE CORPORATION <br />O <br />N <br />O N <br />O � <br />S <br />W Z <br />W o <br />a\ <br />SUFFIX <br />COUNTRY <br />NONE <br />SUFFIX <br />COUNTRY <br />r1 NONE <br />DR <br />3b. INDIVIDUAL'S LAST NAME <br />FIRST NAME <br />MIDDLE NAME <br />CITY <br />STATE <br />POSTAL CODE <br />COUNTRY <br />3c. MAILING ADDRESS <br />200 W. JACKSON #720 <br />CHICAGO <br />IL <br />60606 <br />4. This FINANCING STA I LMLN I covers me rouowmg CoOaleidi. <br />WHOLE HOUSE WATER TREATMENT SYSTEM <br />SUFFIX <br />5. ALTERNATIVE DESIGNATION [if applicable] X LESSEE/LESSOR CONSIGNEE/CONSIGNOR BAILEE/BAILOR SELLER/BUYER AG. LIEN NON -UCC FILING <br />6 r� This FINANCING STATEMENT is to be £led [for record] (or recorded) in the REAL 7. heck to REQUE T SEARCH REPORT(S) on Debtor(s) ❑ All Debtors []Debtor 1 ❑ Debtor 2 <br />8. OPTIONAL FILER REFERENCE DATA <br />6459310 620030335 <br />Prepared by UCC Direct Services, P.O. Box 29071, <br />FILING OFFICE COPY - NATIONAL UCC FINANCING STATEMENT (FORM UCC1) (REV. 05/22/02) Glendale, CA 91209 -9071 Tel (800) 331 -3282 <br />