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...� <br />M <br />IIIIIIII..I� <br />® <br />= n d <br />M > N <br />.� <br />DANCING STATEMENT <br />n � <br />STRUCTIONS (front and back) CAREFULLY <br />0-) <br />t PHONE OF CONTACT AT FILER (optional] <br />N <br />CKNOWLEDGMENT TO: (Name and Address) <br />Platte Valley State Bank & Trust Company, latte Valley Stat <br />w <br />8ink & Trust Company <br />Second Ave <br />_Z223 <br />Kearney, Nebraska 68848 -0430 <br />"2 <br />� t � <br />M <br />E17 <br />c.M -. <br />F•--A <br />Cb <br />F—• <br />cv <br />C.0 <br />n V) <br />ca --i <br />c:-_ >r <br />rrn <br />4 � <br />A <br />co <br />A <br />Q) <br />THE ABOVE SPACE IS FOR FILING OFFICE USE ONLY <br />1. DEBT UH'S EXACT FULL LEGAL NAME - insert only one debtor name (1a or 1b) - do not abbreviate or combine names <br />ECoaORGANIZATION'S NAME <br />OR bler Chiropractic, PLC <br />1b. INDIVIDUAL'S LAST NAME I FIRST NAME MIDC <br />CA <br />C Lt <br />cr)ff <br />ry <br />z <br />d <br />1c. MAILING ADDRESS CITY STATE I POSTAL CODE ]COUNTRY <br />3404 W 13th St., Suite 115 Grand Island NE 68803 USA <br />ld. TAX ID N! SSN OR EIN IADDTINFORE Ile, TYPE OF ORGANIZATION if. JURISDICTION OF ORGANIZATION 1g. ORGANIZATIONAL ID 1/, if any <br />ORGANIZATION Limited Liability �x Z j ���i }j ® NONE <br />(f DEBTOR Com an <br />2. ADDITIONAL DEBTORS EXACT FULL LEGAL NAME - insert only one debtor name (2a or 21b) - do not abbreviate or combine names <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 />OR Platte Valley State Bank &Trust Com any <br />36. INDIVIDUAL'S LAST NAME I FIRST NAME IMIDDLE NAME ISUFFiX <br />3c. MAILING ADDRESS CITY STATE POSTAL CODE COUN I RY <br />810 Allen Drive Grand Island NE ` -699M IJSA <br />4. This FINANCING STATEMENT covers the following collateral: 1-+IXTURF,S: All eoods now or in the future affixed or attached to real estate. <br />5, ALTERNATIVE DESIGNATION [if applicable]: ❑ LESSEE /LESSOR ❑ CONSIGNEE /CONSIGNOR ❑ BAILEE /BAILOR ❑ SELLER /BUYER ❑ AG. LIEN ❑ NON -UCC FILING <br />6. Thy FINANCING STATEMENT is to be filed [for record] (or recorded) in the REAL . Check to REMI�SET SEARCH REPORTIS) on Debtor(sl❑ All Debtors ❑ Debtor 1 ❑ Debtor 2 <br />® ES ATE RECORDS. Attach Addendum [if a licable] [ADDITIONAL F optional] <br />. OPTIONAL FILER REFERENCE DATA <br />Bankers Systems, Inc., St. Cloud, MN Form UCC -I -LAZ 5/30/2001 <br />FILING OFFICE COPY — NATIONAL UCC FINANCING STATEMENT (FORM UCC1) (REV. 07/29/98) <br />