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....,".~.._. ... 200701429 UCC FINANCING STATEMENT ADDENDUM FOLLOW INSTRUCTIONS (front and back) CAREFULLY 9. NAME OF FIRST DEBTOR (1a or 1b) ON RELATED FINANCING STATEMENT 9a. ORGANIZATION'S NAME OR Mid-Plains Center for Behavioral Healthcare Services, Inc. 9b. INDIVIDUAL'S lAST NAME IFIRST NAME IMIDDlE NAME,SUFFIX 10. MISCELLANEOUS: -..-- ---. -- .~- .-.--- -. -- - - - THE ABOVE SPACE IS FOR FILING OFFICE USE ONLY 11. ADDITIONAL DEBTOR'S EXACT FULL LEGAL NAME - insert only ~ name (11 a or 11 b) - do not abbreviate or combine names 11 a. ORGANIZATION'S NAME OR 11 b. INDIVIDUAL'S LAST NAME FIRST NAME MIDDLE NAME SUFFIX 11c. MAILING ADDRESS CITY STATE IPOSTAlCODE COUNTRY 11d. SEE INSTRUCTIONS ItD'l INFO RE 1113. TYPE OF ORGANIZATION 1 1f. JURISDICTION OF ORGANIZATION 11 g. ORGANIZATIONAL 10 #, ~ any ORGANIZATION nNONE DEBTOR I I I 12. 1 ADDITIONAL SECURED PARTY'S 2[ rl ASSIGNOR SIP'S NAME - insert only lIIllI. nama (12a or 12b) 12a. ORGANIZATION'S NAME OR 12b. INDIVIDUAL'S lAST NAME FIRST NAME MIDDLE NAME SUFFIX 12c. MAILING ADDRESS CITY STATE IPOSTAlCODE COUNTRY 13, This FINANCING STATEMENT covers..D timber to be cut or 0 a.....xtractad 16. Additional collateral description: collataral, or is filed as a IZI fixture filing. 14. Description of ra.1 astate: 914 Baumann Dr., Grand Island, NE 68803 A tract of land comprising a part of Lot 2, Golden Age 2nd Subdivision, Grand Island, Hall County, NE, more particularly described as follows: Beginning at the NW corner of said Lot 2; thence E along the North line of said Lot 2; a distance of 372.69 feet; thence deflecting right 135037'20" and running southwesterly, a distance of 511.55 feet, to the West line of said Lot 2; thence northerly along the west line of said Lot 2, a distance of 357.8 feet to the place of beginning. 15, Nama and address of a RECORD OWNER of above.<Jescribad real estate (if Dabtor does not have a record interest): Hall County Housing Authority Grand Island, NE 68801 17, Chack l!llI:t ~ applicable and check llllIl/ one box. Debtor is a n Trust or n Trustee acting with respect to property held in trust or n Decadenh Estate 18, Check!lD)l( if .pplicable and check llllIl/ one box. a Dabtor is a TRANSMITTING UTiliTY Filed in connection with a Manufactured-Home Transaction ~ effective 30 years 10 Filed in conneelion with a Public-Finance Transaelion - effectiv. 30 years FILING OFFICE COPY - UCC FINANCING STATEMENT ADDENDUM (FORM UCC1Ad) (REV. OS/22/02)