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w~ � UCC FINANCING STATEMENT ADDENDUM FOLLOW INSTRUCTIONS (front and hackl CAREFULLY 9, NAME OF FIRST DEBTOR (la or lb) ON RELATED FINANCING STATEMENT 9a. ORGANIZATION'S NAME OR DOUBLE H PARTNERSHIP 9b. INDIVIDUAL'S LAST NAME IFIRSTNAME 10. MISCELLANEOUS: 11. ADDITIONAL DEBTOR'S EXACT FULL LEGAL NAME - insert onl 11a. ORGANIZATION'S NAME OR 200502'700 THE ABOVE SPACE IS FOR FILING OFFICE USE ONLY name (11a or l l b) -do not abbreviate or combine names FILING OFFICE COPY — UGC FINANCING STATEMENT ADDENDUM (FORM UCC1Ad) (REV. 05/22/02) 11 b. INDIVIDUAL'S LAST NAME FIRST NAME MIDDLE NAME SUFFIX HAPPOLD TRACY RENEE 11c. MAILING ADDRESS CITY STATE CODE COUNTRY 449 W BINFIELD ROAD DONIPHAN ]POSTAL NE 68832 l ld. SEE INSTRUCTIONS ADD'L INFO RE 11e. TYPE OF ORGANIZATION 11f. JURISDICTION OF ORGANIZATION l lg. ORGANIZATIONAL ID #, if any ORGANIZATION DEBTOR I I NONE 12. ADDITIONAL SECURED PARTY'S a[ ASSIGNOR S /P'S NAME - Insert only = name (1 2a or 12b) 12a. ORGANIZATION'S NAME OR 12b. INDIVIDUAL'S LAST NAME FIRST NAME MIDDLE NAME SUFFIX 12c. MAILING ADDRESS CITY STATE 1POSTALCODE COUNTRY 13, This FINANCING STATEMENT covers U timber to be out or ''' as- extracted 16. Additional collateral description: collateral, or is filed as a 0 fixture filing. 14. Description of real estate: Sl/2NW1 /4 & E1/2SW1/4 15 -9 -10 - HALL COUNTY 15. Name and address of a RECORD OWNER of above - described real estate (if Debtor does not have a record interest): 17. Check 2DJy if applicable and check pply one box. Debtor is a FiTrust or F1 Trustee acting with respect to property held in trust or Q Decedent's Estate 18. Check =y if applicable and check snLy one box- Debtor is a TRANSMITTING UTILITY Filed in connection with a Manufactured -Home Transaction — effective 30 years Filed in connection with a Public- Finance Transaction -- effective 30 years FILING OFFICE COPY — UGC FINANCING STATEMENT ADDENDUM (FORM UCC1Ad) (REV. 05/22/02)