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200316464 <br />State of Nebraska Space Above This Line For Recording Data <br />DISCLAIMER OF RIGHT TO DESIGNATE HOMESTEAD <br />Each of the undersigned states as follows: <br />Non - Homestead <br />❑ 1 intend to grant a security interest in real property legally described on the attached mortgage or deed of <br />trust. No part of my homestead is presently situated on said real estate, nor will any of my homestead be <br />situated on said property in the future. However, if I establish a homestead on any part of said real estate <br />during the time the mortgage or deed of trust remains unsatisfied and is a lien upon the real estate, I will have <br />no right to make a designation of homestead in the event of a foreclosure or trustee's sale upon such mortgage <br />or deed of trust. <br />Homestead <br />M I intend to grant a security interest in real property legally described on the attached mortgage or deed of <br />trust. My homestead is located on said real estate, and I understand I have the right to make a designation of <br />homestead in the mortgage or deed of trust. If I waive or disclaim the right to designate my homestead I am <br />waiving rights, that I would otherwise have, to retain my homestead in the event of default upon such <br />mortgage or deed of trust. I hereby waive and disclaim the right to designate my homestead. <br />I have read the paragraph checked above, and I understand the contents of that paragraph. <br />This disclaimer was signed before execution of the mortgage or deed of trust. <br />Dated: <br />Dated <br />State of Nebraska <br />County of HAMILTON <br />-aa -0.�, <br />The foregoing instrument was acknowledged before me this 22nd day ofDecember,2003 <br />by RYAN HAPPOLD; SHENTELL L. HAPPOLD <br />(Seal) <br />ia GENERAL NOTARY -State of Nebraska <br />-1lI RITA E. PETERSEN <br />My Comm. Exp. Sept. 30, 2004 <br />My com ssi expires: <br />Notary Public <br />,Exj5 � 0 1987 Bankers Systems, Inc., St. Cloud, MN Form DRDH- LAZ -NE 318/2001 (page 1 of 1) <br />