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<br />200806174 <br /> <br />UCC FINANCING STATEMENT ADDENDUM <br />FOllOW INSTRUCTIONS (fronl.and back) CARE FULL Y <br />9, NAME OF FIRST DEBTOR (fa or f b) ON RELATED FINANOINQ STATEMENT <br />9a OR(lANlZATlON'$ NAME <br /> <br />OR~__.. <br />9b. INDIVIDUAL'S lAST NAME <br />WAGONER <br /> <br />10. MISCELLANEOUS: <br /> <br />IFIRST NAME"''''-'' <br />ISIMON <br /> <br />_.__......_...__....~ <br />IMIDDLENAMEiSUFFIX <br /> <br />THE ASOV!SPACe Il!\ Fl)R FILING OFPICE U$E.O~LY <br /> <br />11.AQDITIQNAL DEBTOR 'SEXACT FULL LEGAL NANe . Insertol1IY.lml neme (11 a or 11b) . do not abbl'O'liat8or c.Otribine nam... <br />11 e. ORGANIZATION'S NAME <br /> <br />OR. 11 b. INDIVIDUAL'S lAST NAME <br />WAGONER <br />11 c. MAIUNG ADDRESS <br /> <br />FIRST NAME <br /> <br />MIDDLE NAME <br /> <br />SUFFIX <br /> <br />DANIEL <br />CITY <br /> <br />STATE POSTAL CODE <br />NE 68883 <br />11g ORGANlZATlONALlD N, hny <br /> <br />COlA'JTRY <br /> <br />17562 W. HUSKER HWY WOOD RIVER <br /> <br />11 d. SEE INS TRUCTIONS ADD'LlNFORE-'f11e. TYPE OF ORGANIZA nON ....-. 111. JURISDICTION OF ORGANIZAi'iC)N <br />ORGANIZATION <br />DEeTOR <br /> <br /> <br />NONE <br /> <br />12. <br /> <br />ASSIGNOR SIP'S NAME -lnsM<>nIY.wJllnome(12a or 12b <br /> <br />OR 17Jl. INDIVIDUAL'S LAST NAME <br /> <br />FIRST NAME <br /> <br />MIDDLE NAME <br /> <br />SUFFIX <br /> <br />'12c. MAIUNG ADDRESS <br /> <br />CITY <br /> <br />'STAri''-'" posY AL CO-DE <br /> <br />toU\iTFl'r"'~' <br /> <br />13. Thi,FINANCING STATEMENT covers timb.r to b. cuI <It <br /> <br />collaleral, or i$lllo~ as a I8l fixllJro filing. <br />14. Do..cnplion of real e~late: <br /> <br />n-extJaclGd 16. Additional co_amral descriplion: <br /> <br />SW 1/4 SEC. 28 T-11 R-12, HALL COUNTY, NE <br /> <br />15. Namo and .ddre.. of. RECORD OWNER of above-deseribed real 68_ <br />(~ Oobtor does not ~.ve . record interesl): <br /> <br />CECILIA B. WAGONER <br />AMANDA J. WAGONER <br />DANIEL J, WAGONER <br />SIMON D. WAGONER <br /> <br />17. C~""k Ql!!J: Ifappll""blEl Md o~""k QJlb; oM bo.. <br />Peblor is a rRlslee aoting Vvith 'espeol to propelty ~ald Inlrusl or Deoed.n~s .Eslata <br />1"8, CI'eek Ql!!J: if appllc:able and c~"".k mili' .0M box <br />O.btor is. TRANSMITTINOlmUTY <br />Filad in connaotion with e ManutaOlured.Home Transaotion - affective 30 years <br />Filed in oonneotion.witha.PubU.o,Finenoe Transection - etfective 30 years <br /> <br />FILING OFFICE COpy - ucc FINANCING $TATEMENT AD.DENDUM (FORM UCC1Ad) (REV. 05/;12102) <br />