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<br />UCC FINANCING STATEMENT ADDENDUM <br />FOllOW INSTRUCTIONS (front and back) CAREFUllY <br />9. NAME OF FIRST DEBTOR (1a or lb) ON RELATED FINANCING STATEMENT <br /> 9a, ORGANIZATION'S NAME <br />OR <br /> 9b, INDIVIDUAL'S LAST NAME rRST NAME riDDLE NAME,SUFFIX 200510710 <br /> VASQUEZ JUAN <br />10, MISCELLANEOUS: <br /> THE ABOVE SPACE IS FOR FILING OFFICE USE ONLY <br /> <br />11. ADDITIONAL DEBTOR'S EXACT FULL lEGAL NAME -lnsertonlY2lll name (11a or 11b) -do not abbreviate orcomb;ne names <br /> <br /> 11a. ORGANIZATION'S NAME <br />OR 11 b. INDIVIDUAL'S LAST NAME FIRST NAME MIDDLE NAME SUFFIX <br />11 c, MAILING ADDRESS CITY STATE rOSTAL CODE COUNTRY <br />11 d. SEE INSTRUCTIONS I fDD'L INFO RE 111 e, TYPE OF ORGANIZATION 11 f. JURISDICTION OF ORGANllA TION 119. ORGANIZATIONALlD #, if any <br /> ORGANIZAllON I I n NONE <br /> DE8TOR I <br />12. II ADDITIONAL SECURED PARTY'S QI fl ASSIGNOR SIP'S NAME - insert only 2Illl name (12a or 12b) <br /> 12a. ORGANIZATION'S NAME <br />OR CARMEL FINANCIAL CORPORATION <br />12b. INDIVIDUAL'S LAST NAME FIRST NAME MIDDLE NAME SUFFIX <br />12c. MAILING ADDRESS CITY STATE I~OSTAL CODE COUNTRY <br />101 EAST CARMEL DRIVE. SUITE 200 CARMEL IN 46032-6127 <br />13. This FINANCING STATEMENT covers 0 timber to be cut 0"0 as,extracted 16. Additional collateral description: <br /> collateral, or is filed as a IZJ fixture filing. <br />14. Description of real estate: <br />1516 N. HUSTON <br />GRAND ISLAND, NE 68803 <br />COUNTY: HALL <br />LEGAL DESCRIPTION: Parcel Number- <br />400116596; WEST LAWN LT 171 <br />WATER TREATMENT SYSTEM <br />MODEL: N/A <br />SERIAL: N/A <br />15. Name and address of a RECORD OWNER 01 above-described teal estate <br /> (if Debtor does not have a record interest): <br /> 17. Check !lll1l! if applicable and check !lll1l! one box. <br /> Debtor is a n Trust or n Trustee acting with respect to property held in trust or n Decedent's Estate <br /> 18. Check!lll1l! if applicable and check 2llill one box. <br /> o Debtor is . TRANSMITTING UTILITY <br /> o Flied in connection with a Manufactured-Home Transaction - effective 30 years <br /> I n Filed in connection with. Public-Finance Transaction - effective 30 yea.. <br /> <br />International Association of Commercial Administrators (IACA) <br />FILING OFFICE COpy _ UCC FINANCING STATEMENT ADDENDUM (FORM UCC1Ad) (REV. OS/22/02) <br />