200804713 - Laserfiche WebLink

Browse

CCC-297 (08-18-04) 200804713 Page 2 of 2 IN WITNESS WHEREOF, the undersigned parties hereto have executed this instrument this (h) day of (i) , (jJ (year). if a corporation: (k) Name of Corporate (Mortgagee) (Owner) '" By (l) Duly Authorized Officer ~.~~, ,''''',',~ --:.--- _.".~~," (m) Title CORPORATE SEAL "Mortgagee" includes holder of any type ofreal estate lien. "'Delete "Mortgagee" or "Owner." (p) STATE OF (q) COUNTY OF Nt.~~ l~ AU- } ss. ACKNOWLEDGMENT: ~Y!^\ On this (r) day of (s) r \ A-'i in the y~ (t) ~(J8' , before me, the undersigned, a Notary Public in and for said State, personally appeared (u) N t..\l.+ ~~oA~~ personally known to me or proved to me on the basis ofsatisfactory 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 (ies), and that by his/her/their signature(s) on the instrument, the individUld{s} or the person on behalf of which the individual{s) acted. execute the instrument. J;GENERAl NOTARY. Slate fI Nebraska SHtu.EY K. SCHROEDER t.tt QImm. Exp. Oct. 5. 201 D (SEAL) My commission expires (w) ID - S -dl.:)l D (MM-DD-YYYY) NOTE: The following statement is made in accordance with the PrivaCy Act of 1974 (5 USC 552a) and the Paperwork Reduction Act of 1995. es amended. The authority for requesting the following information is 7 CFR Part 1436 and the Commodity Credit Corporation Charter Ad, 5 USC 714 et. seq. The Information will be used to determine aligibility for cee Wnanclng for farm, storage and drying equipment. Fumishing the requested informetlon is voluntery; however, without it cee finencing under the program cannot be provided. Failure to fumish the raquested Information will result in denial of eee Wnencing under this program. This Information may be provided to other agencies, IRS, Department of Justice, or other State and Federal law enforcement agencies, and in IlIsponse to e court magistrate or adminlstretive tribunal. The provIsions of criminal and civil freud statutes, including 18 use 286,287,371,641,651, 1001; 15 use 714m; and 31 USC 3729, may be appliceble to the informatfon provided. According to the Paperwork Raduction Act of 1995, en egenCy may not condud or sponsor, end a person is not required to IlIspond to, a collection of information unless it displays a valid OMB control number. The valid OMS control number for this information colledion is 0560.0204. The time required to complete this information colledlon is estimated to averaga 15 minutes per response, Including tha time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. RETURN THtS COMPLETED FORM TO YOUR COUNTY FSA OFFICE.