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<br />Name and address of Beneficiary: <br /> <br />Donald L. & Connie Robertson <br />3804 Calvin Drive <br />Grand Island, NE 68801 <br /> <br />STATE OF NEBRASKA <br /> <br />SS: <br /> <br />COUNTY OF HALL <br /> <br />200512007 <br /> <br />The foregoing instrument was acknowledged before me on <br />De.N..vY\Oe. V' \ , 2005, by Juan Diego Salas Arias and Maria Gloria Salas <br />Rojas, husband and wife. <br /> <br />My commission expires: <br /> <br />MCtfCh O-~ <br /> <br />~~ 1YVUm-uL- <br />Notary Public <br /> <br />9.00 ~ <br /> <br />