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200804802 Page 2 of 2 CCC-297 (08-18-04) IN WITNESS WHEREOF, the undersigned parties hereto have executed this instrument this (h) 2 Cf day of (i) f)') R-y , (j) ;;l.L)EJ j (year). if a corporation: PATHWAY BANK f/k/a STATE BANK OF CAIRO (k) Name of Corporate (Mortgagee) (fJil'tl.:wj ... (n) Individual (Mortgagee) (Owner) ... By+,. ,a-~~/ (I) Duly Authorized Ojji r ~ 'c~. Pfe S: de ~+ (m) Title (0) Individual (Mortgagee) (Owner) ... CORPORATE SEAL "Mortgagee" includes holder of any type of real estate lien. "'Delete "Mortgagee" or "Owner." (P) STATE OF ~(' a.s/!.(J..... (q) COUNTYOF~ On this (r) ~ '1+h day of (s) yY)CL'1 me, the undersigned, a Notary Public in and for said State, personally appeared (u) 0.. 'Y\'\, 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 (ies), and that by his/her/their signature(s) on the instrument, the'iildividUliIts) or the person on behalf of which the. individuaUs) acted. execute the instrument. } ss. ACKNOWLEDGMENT: GENERAL NOTARY. S1llte of Nebraska . DIXIE A.. MCCORD My Comm. Exp. December 18, 2010 (SEAL) &"t W1n~ , v) N2tary Public -<lj 'jH'L 1:2. I {. ';MID . , (M':I.DD-YYYY) My commission expires (w) NOTE: The following statemflnt is made in accordance with the Privacy Act of 1974 (5 USC 552a) and the Pa(J6rwork Reduction Act of 1995, as amended. The authority for requesting the folJowing information is 7 CFR Part 1436 and the Commodity Credit Corporation Charter Act. 5 USC 714 et. seq. The information will be used to determine eligibility for CCC financing for farm, storage and drying equipment. Fumishlng the requested information Is voluntary; however. without it eee financing under the program cannot be provided. Failure to fumish the requested information will result in denial of eee financing under this progrem. This information may be provided to othar agancles, IRS, Department of Justice, or other State and Federal law enforcement agena.,s, and in response to a 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 conduct 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 cotlee/ion is 0560-0204. The tima 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, end completing and reviewing the collection of Information. RETURN THtS COMPLETED FORM TO YOUR COUNTY FSA OFFfCE,