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<br />UCC FINANCING STATEMENT ADDENDUM <br />FOLLOW INSTRUCTIONS ifront and back' CAREFULLY <br />9. NAME OF FIRST DEBTOR (1a or 1b) ON RELATED FINANCING STATEMENT <br /> ga. ORGANIZATION'S NAME <br />OR iMIDDlE NAME,SUFFIX 200510261 <br /> 9b, INDIVIDUAL'S lAST NAME iFIRST NAME <br /> ANDAZOLA JORGE <br />10. MISCELLANEOUS: <br /> THE ABOVE SPACE IS FOR FILING OFFICE USE ONLY <br /> <br />11. ADDITIONAL DEBTOR'S EXACT FULL LEGAL NAME. insert only QM name ("a or "b) - do notabbrevi.te or combine names <br /> <br /> l' a, ORGANIZATION'S NAME <br />OR l' b. INDIVIDUAL'S lAST NAME FIRST NAME MIDDLE NAME SUFFiX <br />, , c. MAILING ADDRESS CrTY STATE IPOSTAL CODE COUNTRY <br />"d, SEE INSTRUCTIONS I ADD'L INFO RE T' ,. TYPE OF ORGANIZATION , 11. JURISDICTION OF ORGANIZATION , '9, ORGANIZATIONAL 10 #, If any <br /> ORGANIZATION I I n NONE <br /> DEBTOR I <br />12. 171 ADDITIONAL SECURED PARTY'S Q.[ fl ASSIGNOR SIP'S NAME - insert only Qill! name <'2. or , 2b) <br /> , 2a. ORGANIZATION'S NAME <br />OR CARMEL FINANCIAL CORPORATION <br />, 2b. INDIVIDUAL'S LAST NAME FIRST NAME MIDDLE NAME SUFFIX <br />, 2c. MAILING ADDRESS CITY STATE I POSTAL CODE COUNTRY <br />101 EAST CARMEL DRIVE SUITE 200 CARMEL IN 46032-6127 <br />13. This FINANCING STATEMENT cove,. D timber to be cut or D as-extr.cted 16, Additional collateral description: <br /> collateral, or is filed as a III fixture filing. <br />14. Description of real estate: <br />307 E 6TH STREET <br />GRAND ISLAND, NE 68801 <br />COUNTY:HALL - <br /> .- <br />LEGAL DESCRIPTION: W 22' OF LT 3 & E 21' OF <br />N 89' & E 5' OF S 43' L T 4 BLK 21 ORIGINAL <br />TOWN NOW CITY OF GRAND ISLAND, HALL <br />COUNTY, NEBRASKA Parcel Number: 400001632 <br />WATER TREATMENT SYSTEM <br />MODEL;HYDRO/PROLINE REG REV OSMOSIS <br />SERIAL:234133,507007 <br />15. Name and address of a RECORD OWNER of above-described real estate <br /> (if Debtor does not have a record intere.t): <br /> 17. Check 2Dl'l if applioable and check 2Dl'l one box. <br /> Debtor is a n Trust or n Trustee acting with respect to property held in trust or n Decedent's Estate <br /> 18. Check 2Dl'l ifapplicable and check 2Dl'l one box, <br /> D Debtor is a TRANSMITTING UTILITY <br /> D Filed in connection with a Manufactured-Home Transaction - effective 30 y@ars <br /> 10 Filed in connection with a Public~Finance Transaction ~ effective 30 years <br /> . . <br /> <br />International ASSOCiation of Commercial Administrators (IACA) <br />FILING OFFICe COPY - UCC FINANCING STATEMENT ADDENDUM (FORM UCC1Ad) (REV. 05/22/02) <br />