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A .. 200506620 UCC FINANCING STATEMENT ADDENDUM FOLLOW INSTRUCTIONS (front and back) CAREFULLY 9. NAME OF FIRST DEBTOR (1a or 1b) ON RELATED FINANCING STATEMENT 9a. ORGANIZATION'S NAME OR Cobler Chiropractic, PLC 10. MISCELLANEOUS: THE -ABOVE SPACE IS FOR FILING OFFICE USE ONLY 11 ADDITIONAL EXACT FULL LEGAL NAME - insert only one name 0 1a or 11b) - do not abbreviate or combine names 12c, MAILING ADDRESS 13, This FINANCING STATEMENT covers ❑ timber to be cut or ❑ as-ext collateral, or is filed as a ® fixture filing. 14. Description of real estate: LOT 1, UNIT 115, CONESTOGA MALL SEVENTH SUBDIVISION, GRAND ISLAND, HALL COUNTY, NEBRASKA 15. Name and address of a RECORD OWNER of above - descri bed real estate (if Debtor does not have a record interest): CITY STATE 1POSTALCODE 16. Additional collateral description: 17. Check 2ply if applicable and check only one box. Debtor is a ❑ Trust or ❑ Trustee acting with respect to property held in trust or ❑ Decedent's Estate 18. Check 2 =1 if applicable and check on�l r 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 -- NATIONAL UCC FINANCING STATEMENT ADDENDUM (FORM UCC1Ad) (REV. 07/29/98) Bankers Systems, Inc., St. Cloud, MN Form UCC,IADD -LAZ 5/30/2001 11a. ORGANIZATION'S NAME OR 11 b. INDIVIDUAL'S LAST NAME FIRST NAME MIDDLE NAME SUFFIX 11 c. MAILING ADDRESS CITY STATE 1POSTALCODE COUNTRY 11d. TAX ID #: SSN OR EIN ADD'L INFO RE jile. TYPE OF ORGANIZATION 1lf. JURISDICTION OF ORGANIZATION 11 g. ORGANIZATIONAL ID #, if any ORGANIZATION DEBTOR I ❑ NONE 12. 7 ADDITIONAL SECURED PARTY'S or ASSIGNOR S /P'S NAME - insert only one name (12a or 121b) 12a. ORGANIZATION'S NAME OR 126. INDIVIDUAL'S LAST NAME I FIRST NAME MIDDLE NAME ISUFFIX 12c, MAILING ADDRESS 13, This FINANCING STATEMENT covers ❑ timber to be cut or ❑ as-ext collateral, or is filed as a ® fixture filing. 14. Description of real estate: LOT 1, UNIT 115, CONESTOGA MALL SEVENTH SUBDIVISION, GRAND ISLAND, HALL COUNTY, NEBRASKA 15. Name and address of a RECORD OWNER of above - descri bed real estate (if Debtor does not have a record interest): CITY STATE 1POSTALCODE 16. Additional collateral description: 17. Check 2ply if applicable and check only one box. Debtor is a ❑ Trust or ❑ Trustee acting with respect to property held in trust or ❑ Decedent's Estate 18. Check 2 =1 if applicable and check on�l r 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 -- NATIONAL UCC FINANCING STATEMENT ADDENDUM (FORM UCC1Ad) (REV. 07/29/98) Bankers Systems, Inc., St. Cloud, MN Form UCC,IADD -LAZ 5/30/2001