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201005953 CCC-297 (08-18-04) Page 2 of 2 1N WITNESS WIiEREOF, the undersigned parties reto have ex cuted this instrument this (h) ~y _ day of (i) G) ~~ ~ (year). if a corporation: LLTEHR FARMS, INC. (k) Name of C CORPORATE SEAL *(SORROWER (fli) 7'II~L' "Mortgagee" includes holder of any type of real estate lien, D f L PORK, INC. I ~ tt ) * SY: bUL AUTH RIZED OFFICER )"~ I~ TITLE *Delete "Mortgagee" or "Owner." (p) STATE OF (g) COUNTY OF ss. ACKNOWLEDGMENT: On this (r) ©1 r~ day of (s) in the year (t) ~~U, before *~e:~ me, the undersigned, a Notary Public in and for said State, personally appeared (u) , personally known to me or proved to me on the basis of satisfactory evidence to be the individual(s) whose name(s) is (are) subscribed to the within instrument and acknowledged to me that he/she executed the same in his/her/their capacity (ies), and that by his/her/their signature(s) on the instrument, the individual(s) or the person on behalf of which the individual(s) acted, execute the instrument. GENERAL NOtAHI' -State of Netxaska (SEAL) c JANICE K. BQEMLE (v) Notary Public My Comm. E>~. Nhvch 27, 2013 My commission expires (w) <*~Loyd A. Luehr, President of Luel~rr Farms, Inc. and Dean A. Luehr, President of D at L Pork, Inc. (MM-DD-YYYY) NOTE: The following statement is made in accordance with the Privacy Act el 1974 (5 USC 552a) and the Paperwork Reduction Act of 7995, as amended. The authority Por requesting the /ollowing information is 7 CFR Part 1436 and the Commodity Credit Corporation Charter Act, 5 USC 774 et. seq. The in/ormation will be used fo getermine eligibility for CC financing /or term, storage and drying equipment. Furnishing the requested information is voluntary; however, without it GCC financing under the program cannot be provided. Failure to furnish the requested information will result in denial d/CCC /inanWng under this program. This information maybe provided to other agencies, IRS, Department of Justice, or other State and Federal law enPoroement agencies, and in response to a court magistrete or administrative tribunal. The provisions of criminal and civil fraud statutes including 18 USC 286, 287, 377, 641. 651, 1001; 15 USC 714m; and 31 USC 3729, may be applicable to the information provided. According to the Paperwork Reduction Act o/ 1895, an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a valid OMB control number. The valid OMB control number lorthis in/ormation collection is 0560-0204. The bme required to complete this information collection is estimated to average 75 minutes per response, incuding the lima for n: viewing inswctions, searching existing data sources, gathering and malntalning the data needed, and completing and reviewing the collection of information. RETURN THIS COMPLETED FORM TO YOUR COUNTY F5A OFFICE.