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2010013'72 <br />CCC-297 (08-18-04) <br />Page 2 of 2 <br />IN WITNESS WHEREOF, the undersigned partie hereto have executed this instrument <br />this (h) ~ 5* day of (i) ~-~-~" , G) ~ t a (year). <br />if a corporation: <br />PANOWICZ FAMILY FARMS, L.L.C. <br />(k)NameofCorporate;_'._`_.~~ fBwareer~~ * ~O~NE~~ <br />By ~".. w ~ ,.. , <br />(1) Duly Authorized Officer <br />() '~I~u * <br />~~~ <br />(o) Individual <br />SARITA A PANG <br />MANAGER/__MEMBER -. ---------_.-..._- _.. __.. <br />(m) Title <br />CORPORATE <br />SEAL <br />"Mortgagee" includes holder of any type of real estate lien. <br />*Delete "Mortgagee" or "Owner." <br />(p) STATE OF N~BRASxA <br />(~ COUNTY OF ALL ss. ACKNOWLEDGMENT: <br />~~ <br />On this (r) day of (s) ~d2-t,hF- in the year (t) ~ la ,before <br />me, the undersigned, a Notary Public in and for said State, personally appeared (u) ~ ~ ~ ~f4nl o ua t~ Z ~'`- ,5A ~.tTl4 <br />personally known to me or proved to me on the basis of satisfactory evidence to be the individual(s) whose name(s) is (are) ~ 17gn~u1'e 2.. <br />subscribed to the within instrument and acknowledged to me that he/she executed the same in his/her/their capacity (ies), `~` ~ ~Q-~+~~ A <br />and that by.-his/herltheir signature{s}en-the ittstruu~erGt, the individual(s) or the person on behalfflf v~hich t-he--i~iai~ual(s}-- ~ A+a~ ~ ~~ <br />acted, execute the instrument. <br />(SEAL) ~~ <br />Not ublic <br />GENERAL NpT11RY - $fafe of Nebras Y commission expires (w) <br />SHEl,1.EY K $GHliQEDER <br />~- ,~~.~, f~ty c.+?mm. ~~-. oar. ~. ?nfo <br />(MM-DD-YYYY) <br />NOTE• ThB following statement is made in accordance with the PrivaCyACt of 1974 (5 USC 552a) and thB Paperwork Reduction Act of 1995, as amended. The authority for requesting <br />thB following information is 7 CFR Part 1436 and the Commodity Credit Corporation Charter Act, 5 USC 714 et. seq. The information will be used to determinB elglblllty for CC <br />financing for farm, storage and drying equipment. Furnishing the requested information is voluntary; however, without i[ CCC financing under the program cannot be provided. <br />Failure to furnish the requested Information will result in dental of CCC financing under this program. This information may be provided to other agences, IRS, Department of <br />Justice, or other State and Federal law BnforCement agencies, and in response to a court magistrate ar administr'ative tribunal. The provisions of criminal and civil fraud statutes <br />including 18 USC 286, 287, 371, 641, 651, 1001; i5 USC 714m; and 31 USC 3729, maybe applicable ro the information provided. <br />According ro the Paperwork ReduCtlon Act of 1995, an agency may not conduct w sponsor, and a person is rrot required ro respond ro, a collection of information uMess it <br />displays a valid OMB Control number. The valid OMB control number for this inormaton collection is 0560-0204. ThB tlma required to complete this information collection is <br />estimated ro average 15 minutes per response, including the time for rev/ewing Instructions, searching existing date sources, gathering and maintaining the data needed, and <br />completing and revlewing the collection of information. RETURN TWIS COMPLETED FORM TO YOUR COUNTY FSA OFFICE, <br />~ V - ~ -[ cam., <br />