200804712 - Laserfiche WebLink

Browse

CCC.297 (08-18-04) 200804712 Page 2 of 2 IN WITNESS WHEREOF, the undersigned parties hereto have executed this instrument this (h) day of (i) , 0) (year). if a corporation: (I) Duly A uthorized Officer ~~ (Qo.,',,,,,,,, (Borrower) Albert W fuellercO ~ ~ /')~ l4Y' 1'(!,Jt /.ILL~J fA"L-- (0) Individual (M9rtg6lgB9) (Q1l'.'fBr) '" (Borrower) Michelle L Moeller (k) Name of Corporate (Mortgagee) (Owner) '" By (m) Title CORPORATE SEAL "Mortgagee" includes holder of any type of real estate lien. "'Delete "Mortgagee" or "Owner." (p) STATE OF _~ l.fa.8A~[(A (q) COUNTY OF l-\~ LL- } SS. ACKNOWLEDGMENT: On this (,) .3:fj"~ day of 1>)_1\ \ ~ in the year (t)~ 'i: , before me, the undersigned, a Notary Public in and for said State, personal y appeared (u).bI...i."tJl:;r W M...t.u:t.t.... ~ fV\\~....u. personally known to me or proved to me on the basis of satisfactory evidence to be the individual(s) whose name(s) is (are) subscribed to the within instrument and acknowledged to me that he/she executed the same in his/her/their capacity (ieti), ID1~J!1..~tbY his/her/their signature(s) on the instrument, the indiYid\J!llU) QrJI:1~_l'ers!,)!l oo_behalf of which the individuaUs) acted. execute the instrument. L~]~~ , (SEAL) ..........,:1_ J;GENERAL tIlTAftY . Slate of Nebr.. SHEUlY It !l)lROEDER MyComm. &po Oct 5. 2010 ~~ My commission expires (w) ID-S-~~/t) (MM-DD-YYYY) NOTE: The following statement is made in accordance with the Privacy Act of 1974 (5 use 552a) and the Paperwork Reduction Act of 1995, as amended. The authotity for requesting the following information is 7 CFR Pari 1436 end the Commodity Credit Corporation Charlar Act, 5 use 714 et. seq. The information will be used to determine eligibi/ffy for CCC financing for farm, storage and drying equIpment. Furnishing the requested informetion is VOluntary; however, without it CCC financing under the program cannot be provided. Failure to furnish the requested information will result in denial of eee finanCing under this program. This information may be provided to other egencies, IRS, Department of Justice, or other State and Federal law enforcement agencies, and In response to e court magistrate or administrative tribunal. The provisions of criminal and civil fraud statutes, including 18 USC 286, 287, 371, 641, 651, 1001; 15 USC 714m; and 31 use 3729, may be applicable to the Information provided. According to the Paperwork Reduction Act of 1995, an agency may not conducl or sponsor, and a person is not required to respond to, a collection of information unless it displays a valid OMS control number. The valid OMS control number for this information collecllon is 0560.0204. The time required to complete this information collection is estimated to average 15 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. RETURN THIS COMPLETED FORM TO YOUR COUNTY FSA OFFICE.