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<br />-- ,:.:..~,.
<br />
<br />CCC.297 (08-18-04)
<br />
<br />~OO~OI;2.71
<br />
<br />Page 2 of 2
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<br />IN WITNESS WHEREOF, the undersigned parties hereto have executed this instrument
<br />this (h) ...,3D't\!!; day of (i) ::r u...L.-~
<br />
<br />, 0)
<br />
<br />2008
<br />
<br />(year).
<br />
<br />if a corporation:
<br />
<br />METROPOLITAN LIFE INSURANCE COMPANY
<br />
<br />(n) Individual (Mortgagee) (Owner) ·
<br />
<br />
<br />ofcor~or~(~"l tggaaggee~e) (0ll'1181~ ·
<br />
<br />,'t~f/ ~
<br />
<br />
<br />(0) Individual (Mortgagee) (Owner) ·
<br />
<br />By
<br />""'>~"';0;;i,;~",.*~~,~uly AUll1.~~-q!ll.f%:~--'--
<br />
<br />DanaP. Burden, Director
<br />(m) Title
<br />
<br />kfrbRP6fii:rE
<br />ls'Fiir.
<br />
<br />"Mortgagee" includes holder of any type ofreal estate lien.
<br />.Delete "Mortgagee" or "Owner."
<br />
<br />(p) STATE OF
<br />
<br />(q) COUNTY OF
<br />
<br />Iowa
<br />Polk
<br />
<br />} ss. ACKNOWLEDGMENT:
<br />
<br />On this (r) ,J.l) 't!1 day of (s) -J ~ -
<br />
<br />me, the undersigned, a Notary Public in and for said State, personally appeared (u)
<br />personally known to me or proved to me on the basis of satisfactory evidence to be the individual(SC) whose name(~ is
<br />(~ subscribed to the within instrument and acknowledged to me that helm executed the same in his~ capacity
<br />(_, ~n~, that by hi$~x ~Ii.lliltY!eL~2!!,!h~jp~tru~n.!,_!he;individMal~g!the _p_tz.~~,~ 9pbehalf of wh' h he ,_'0',
<br />individual~ acted. execute the instrument. corporation
<br />
<br />JEANNE p CINNAMOrt~, L) /, ,I
<br />Notarial Seal. IOWA \~D' ..
<br />CommtNlon No. 745851
<br />My Commle,lon Explr., March 11. ...
<br />My commission expires (w)
<br />
<br />in the year (I) 2008 , before
<br />Dana P. Burden------------
<br />
<br />
<br />(v) Not,ary Public
<br />
<br />(MM-DD-YYYY)
<br />
<br />NOTE:
<br />
<br />The following statement is made In accordance with the Privacy Act of 1974 (15 usc !5!52a) and the Peperwork Reduction Act of 1995, as amended, The authority for requesting
<br />the fot/owing Information is 7 CFR Parl1436 IInd the Commodity Credit Corporation Chllrter Act, 5 USC 714 et, seq, The information wilt be used to determine eligibility for
<br />eee financing for farm. sto/'ilge IInd drying eqUipment. Furnishing the requested Information Is vatuntal}'; however, without it CCC financing under the program cllnnot be
<br />provided, Flliluf/J to furnish the requested information will result In denlat of CCC financing under this program, This informlltion mllY be provldad to other agencies, IRS,
<br />Deparlment of Jus/Ice, or other State and Federal law enforcement agancles. and in response to a court m/lgistrate or administrative trtbunlll, The provisions of criminal and
<br />civil fraud statutes, including 18 USC 286,287.371,641.651, 1001; 15 USC 714m; and 31 USC 3729, may be applicable to the information provided.
<br />
<br />According to the Pllperwork Reduction Act of 1995, IIn agency may not conduct or sponsor, and II person is not required to respond to, a collection of Informlltion unless it
<br />displays a valid OMB control number, The valid OMB control number for this Information collactlon is 0560-0204. The time required to complete this information collection is
<br />estimated to average 15 minutes per response, including tha time for reViewing instructions, searching existing data sources. gathering and maintaining the datil needed, and
<br />completing and reviewing the collection of information, RETURN THtS COMPLETED FORM TO YOUR COUNTY FSA OFFtCE.
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