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Thk FRAAW F6 STATU a k pneeMd to • FOW9 ONk« Fer W" <br />puswef to the U"W "o Ceerreer" CO& 3. Mmurity date (if any) <br />1. Deblor(s�Nome(Lost Nome First) 2. IMbrorls)Address This space for use of Filing Officer. <br />(Date, time, number and Fiing Office. ) <br />LAKEVIEW HOMES, INC. Box 1534 or 004245 <br />Grand Island, Nebraska <br />68802 <br />4. Secured "(in) <br />BEVERLY ENTERPRISES <br />Q Auigned Porry(iea) <br />El. This financing statement covers the following types (or items) of property <br />5. Secured Porty(ies) Address <br />873 South Fair Oaks Avenue <br />Pasadena, California 91105 <br />7. Assigned Pcury(ies)Addrea <br />All of Debtor's right, title and interest in and to <br />the fixtures, furniture, furnishings, inventory, <br />supplies, machinery, equipment and personal property <br />of every kind whatsoever located at the nursing home <br />commonly known as Heritage Village of Grand Island <br />South more particularly described on Exhibit "A" <br />attached hereto. <br />Description of Real Estate. (Ustim— .lydapplicable) <br />See Exhibit "A" attached hereto. <br />Chec4 (r)dcovered: I JProcoeds of collateral are also covered. ( )Praducfs of Collalarol ore also covered. No of oddrhanoi shoats presen+ed. ( ) <br />Ff.dwi�hCircuncourtclerkof Hall (Real Estate) —County. ( ) Secretory of State. <br />REVIEW HOMES, INC. _BEVERLY ENTERPRISES <br />ay: By. <br />S' ep of oils) Signmurels) of Secured Party(,es) <br />,um owe (*'Y lhafwm[d lrrransrrp statement i. atNrrored by the SKrerory at Star. and the ArkanWt Cnmmnuorr on Umlorm Stare law. <br />STANDARD FORM - UNLFORMCOWMItCIAt COO FORM UCCA Forms may be purchased from Dernociat iMg. d Litho. Co 1 tq East 2nd St Lule Rock, Arkonxm <br />a <br />