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<br />CCC-297 (08-18-04)
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<br />,A DO 'it) i;L 7J-
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<br />Page 2 of 2
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<br />this (h)
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<br />IN WITNESS WHEREOF, the undersigned parties hereto have executed this instrument
<br />c::a. ? r,A/ day of (i) ..Ju...l\.1
<br />I
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<br />, 0) ...:< bD 8" (year).
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<br />if a corporation:
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<br />FARM CREDIT SERVICES OF AMERICA
<br />(k) Name of Corporate (Mortgagee) (OIrnsr) '"
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<br />(n) Individual (Mortgagee) (Owner) '"
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<br />~ v
<br />By ~ ?-- ~~
<br />(l) Duly A :;;hd~ed Officer
<br />
<br />(0) Individual (Mortgagee) (Owner) '"
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<br />A $S IS T~,.....,.,..'c.--<&-e.tt'-uJ!!,Ai g,
<br />(m) Title
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<br />$A,c...ec; r"" c/;J-
<br />
<br />-''''''''.
<br />
<br />CORPORATE
<br />SEAL
<br />
<br />"""I""",,
<br />....',' ~\\ce!S Of I..,
<br />...... <::>e\;.......411} """
<br />.$' Jr,\..o?-.PORA;..!.% ~
<br />Igl" Q enlOO,?
<br />; ~ ~.~ :
<br />; '. CHARTERED .: $
<br />0;. . ..//. ".... · . ::
<br />0;. ..vi" 1 "f;::;v... ::
<br />',- ..' ~ .. :'II;
<br />" Q ....10.. '0 ......
<br />"'",'41AHA I V.:'f:, "........
<br />""" II """
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<br />"Mortgagee" includes holder of any type of real estate lien.
<br />"'Delete "Mortgagee" or "Owner."
<br />
<br />(p) STATE OF
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<br />(q) COUNTY OF
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<br />Jebra :s.ko...
<br />Hall
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<br />}
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<br />88.
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<br />ACKNOWLEDGMENT:
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<br />~1~."""'-
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<br />On this (r) c:lP rp day of (8) ..:Tu....L'1 in the year (t) 400lr, before
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<br />me, the undersigned, a Notary Public in and for said State, personally appeared (u) RoY'\.. L.. Rq~sex-
<br />personally known to me or proved to me on the basis of satisfactory evidence to be the individual(s) whose name(s) is
<br />(are) subscribed to the within instrument and acknowledged to me that he/she executed the same in his/her/their capacity
<br />~ies!',and that by hi~~.t!!e~~~nfl.!ure~s) on the instrwnent, the indivi~ual(s~_ o~,~~P_~.~~on?n behalf of which the
<br />mdlvlduaUs) acted. execu1e e Instrument. -
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<br />i"::~~
<br />.~;;,l-.~,,-
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<br />
<br />GENERAL fIlTARY.'" rI__
<br />LYNDA K. SUNDBERG
<br />ComII. ..... 23. 2012
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<br />(SEAL)
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<br />~h.~~J~
<br />
<br />: .\ " ," '(v) ;Notary Public --- - a
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<br />My commission expires (w)
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<br />tJ/- ~.3 - 6l.0/~
<br />(MM-DD- ffff)
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<br />NOTE:
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<br />The following statement Is mede In eccordance with Ihe Prlvecy Act of 1974 (5 USC 552a) end the Peperwork Reduction Act of 1995, es emended. The authority for requesting
<br />the following Information is 7 CFR Parl1436 and the Commodity Credit Corporation Charter Act, 5 USC 714 et, seq, The Information will be used to datermlne ellQlbIlity for
<br />cee ffnancing for lerm, storage and drying equipment, Fumlshing the requested informetion is voluntery: however, without it CCC financing under the program cannot be
<br />provided. Failure to fumish the raquested information will result in denial of eee financing under this program. This information may be provided to other agencies, IRS,
<br />Deparlment of Justice, or other State and Federe/law enforcement agencies, and in response to a court magistrate or administrative tribunal. The provisions of crimine/and
<br />civil fraud statutes, Including 18 USC 286,287,371,641.651, 1001: 15 USC 714m; end 31 USC 3729, may be applicable to the information provided.
<br />
<br />According to the Paperwork Reduction Ae/ of 1995, an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it
<br />displeys a velid OMB control number. The velid OMB control number for this informetion collee/lon is 0560-0204. The time required to complete this information collection is
<br />estimated to everege 15 minutes per response, including the time for reviewing instrue/ions, seerching existing data sources, gathering and maintaining the date needed, and
<br />completing and reviewing the collection ofinformetion. RETURN THIS COMPLETED FORM TO YOUR COUNTY F$A OFFICE.
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