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Signed this day of 20! <br />Lienor: <br />By: <br />Officer or Agent <br />200506'768 <br />State of )i oe <br />County of �G } <br />On <br />20 before me, - .� - -- <br />appeare !G/hae <br />personally known to me (or proved to me on the basis of satisfacYory evidence) to be the person(s) whose name(s) is /are <br />subscribed to the within instrument and acknowledged to me that he /she /they executed the same in his /her /their authorized <br />capacity(ies), and that by his /her /their signature(s) on the instrument the person(s), or the entity upon behalf of which the <br />person(s) acted, executed the instrument. <br />WITNESS my hand and official seal <br />Signature <br />Signature of Notary jF <br />GENERAL NOTARY • State of Nebraska <br />DENICE R. KRUSEi <br />My Comm. Exp. Sept. 25, 2006 <br />I , Affiant Known Produced ID <br />Type of ID 42 Z / g 7 <br />(Seal) <br />GENERAL NO - State of Nebraska <br />pEI R. KRUSE <br />My Comm. Exp, Sept. 25, 2006 <br />Page 2 <br />wwwsocrates.com C 2004, Socrates Media, LLC <br />LF136 • Rev. 04104 <br />