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UCC FINANCING STATEMENT ADDENDUM FOllOW INSTRUCTIONS (front and back) CAREFUllY 9. NAME OF FIRST DEBTOR (la or 1 b) ON RELATED FINANCING STATEMENT 9a. ORGANIZATION'S NAME OR 9b. INDIVIDUAL'S LAST NAME r'RST NAME IMIDDLE NAME,SUFFIX LOPEZ EZEQUIEl 200600235 10. MISCEllANEOUS, .. THE ABOVE SPACE IS FOR FILING OFFICE USE ONLY 11. ADDITIONAL DEBTOR'S EXACT FUll lEGAL NAME - insert only Q!ll! name (lla or llb). do not abbreviate or combine names 11 a. ORGANIZATION'S NAME OR l1b.INDIVIDUAL'S LAST NAME FIRST NAME MIDDLE NAME SUFFIX 11 c. MAILING ADDRESS CITY STATE IPOSTALCODE COUNTRY 11d. TAX 10 #: SSN OR EIN IADD'L INFO RE 111e. TYPE OF ORGANIZATION 111. JURISDICTION OF ORGANIZATION 119. ORGANIZATIONAL 10 #, If any g~;;;~ZATION I I I n NONE 12. l ADDITIONAL SECURED PARTY'S Q[ rl ASSIGNOR SIP'S NAME - insert only Q!ll! name (12a or 12b) 1 2a. ORGANIZATION'S NAME OR 12b. INDIVIDUAL'S LAST NAME FIRST NAME MIDDLE NAME SUFFIX 12c. MAILING ADDRESS CITY STATE jPOSTAlCODE COUNTRY 13. This FINANCING STATEMENT covers 0 timber to be cut or 0 as-extracted 16. Additional collateral description: collateral! or is filed as a ~ fixture flllng. 14. Description of real estate: PARCEL 200511808 lOT 4, BLOCK 5, GllBERTS 2ND ADDITION TO THE CITY OF GRAND ISLAND, HAll COUNTY, NEBRASKA, ACCORDING TO THE RECORDED PLAT THEREOF, AS IN PLAT MAP A, PAGE 17 PARCEL 34 15. Name and address of e RECORD OWNER of above.described real estate (if Debtor does not have a record interest): 17. Check Q ~ applicable and check Q one box. Debtor is a n Trust or n Trustee acllng with respect to property held In trust or n Decedent's Estate 18. Check Q if applicable and check Q one box. o Debtor is a TRANSMITTING UTILITY D Flied In connection with a Manufactured-Home Transaction - effective 30 years I r1 Flied in connection with a Public-Finance Transaction - effective 30 years FILING OFFICE COpy - NATIONAL UCC FINANCING STATEMENT ADDENDUM (FORM UCC1Ad) (REV. 07/29/98)