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200310421 State of Nebraska Space Above This Line For Recording Data DISCLAIMER OF RIGHT TO DESIGNATE HOMESTEAD Each of the undersigned states as follows: Non - Homestead ® 1 intend to grant a security interest in real property legally described on the attached mortgage or deed of trust. No part of my homestead is presently situated on said real estate, nor will any of my homestead be situated on said property in the future. However, if I establish a homestead on any part of said real estate during the time the mortgage or deed of trust remains unsatisfied and is a lien upon the real estate, I will have no right to make a designation of homestead in the event of a foreclosure or trustee's sale upon such mortgage or deed of trust. Homestead ❑ I intend to grant a security interest in real property legally described on the attached mortgage or deed of trust. My homestead is located on said real estate, and I understand I have the right to make a designation of homestead in the mortgage or deed of trust. If I waive or disclaim the right to designate my homestead I am waiving rights, that I would otherwise have, to retain my homestead in the event of default upon such mortgage or deed of trust. I hereby waive and disclaim the right to designate my homestead. I have read the paragraph checked above, and I understand the contents of that paragraph. This disclaimer was signed before execution of the mortgage or deed of trust. Dated: 7- 03 -- Mortgagor/Trustor Dated State of Nebraska County of HAMILTON Mortgagor /Trustor The foregoing instrument was acknowledged before me this 19th day of May, 2003 by LOIS F. NIELSEN A SINGLE PERSON GENERAL NOTARY-State of NebraSka RITA E. PETERSEN My commission ex i es: My Comm. Exp. Sept. 30, 2004 mom 'OE 'ldag bx3 UU103 A" _ Notary Public NEISU7319d 'A tf.1.IM I�� "sejgenl ,o a;e'.; J, i "' 7 1VY -IN39 C 1987 Bankers Systems, Inc., St. Cloud, MN Form DRDH- LAZ -NE 3/8/2001 (page 1 of 1 )