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�fl�1����� <br />CCC-297 (08-18-04) <br />Page 2 of 2 <br />IN WITNESS WHEREOF, the undersigned parties hereto have executed this instrument <br />` this (h) � Ty day of (i) � ebi- �A c. v- y ,(j) �LD /l (year). <br />! <br />if a corporation: <br />FARM CREDIT SE OF AMERICA ,a � ,�/�> <br />(k) Name of Corporate (Mortgagee) (Owner) * � 1 dividual ner) * D BORROWER <br />D WOITASZ WSK <br />r <br />�Y _ �" • _.�________� (o) Indil�irlti , � (�hvner) * Arm BORROWER <br />(1) DulyAuthorized O�cer �� M so�rr <br />i�ss r. �o�c°�o�e,��� s�:�.�.Er��� <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 1U 2��-cz 5 K�, <br />(q) COUNTY OF /-�a / / } ss. ACKNOWLEDGMENT: <br />r.� ` <br />On this (r) g day of (s) �� D�c- � c� Y _Y __ — in the year (t) .�o f/ , befare <br />me, the undersigned, a Notary Public in and for said State, personally appeared (u)� ,.;�,� � o`Y; ���'¢ "� i� o� !� �s ��-- <br />, �e � <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) <br />subscribed to tbe with'rn instrument and aciaiowledged tu me that heistie execu�ed tii� s�ui�e in his�'her/ti capac;iiy (ics}, <br />and that by hisiherJtheir signature(s) on the instrument, the individual(s) or the person on behalf of which the individual(s) <br />acted, execute the instrument. <br />�ENERAL NOTARY - State of Nebraska <br />LYNDA K. 3UND8EFiG (SEAL) <br />My Comm. ExQ..laa, 23, 2012 ' <br />(v) Notary Public <br />My commission expires (w) G/ – � �3 � � o �Z <br />(MM-DD-YYYY) <br />The following Statement is made in accortiance with the Privacy Act a/ 1974 (5 USC 552a) and the Paperwork Reduc6on Act o11995, as amended. The authonfy /or requestic <br />the /ollowi� information is 7 GFR Part 1436 and tAe Commodity Credif Corporafion Charter Ad, 5 USC 714 ef. seq. The informatlon wi�i be used to determine eligibiiity Ior CC <br />financing for /arm, storaqe and drying equipment. Fumishing the requested in/ormation is vo/untary,� however, without it CCC �nandng under the program cannot be provided. <br />Failure to fumish the requested in/ormation will result in denial a/CCC finandng under this proqram. This inlormation may be provided to other agencies, IRS, Department of <br />Justice, or other State and Federal law enforcement agencies, and in respanse to a court magistrafe or administ2five tribunat The provisions of criminal and civil /reud statut� <br />including 18 USC 286, 287, 371, 641, 651, 1001; 15 USC 714m; and 31 USC 3729, may be applicable to the inlormation provided. <br />According to the Papenvork Reduction Act af 1995, an agency may not conducf or sponsor, and a person is nof required fo respond to, a collection o/ inlormaBOn unless it <br />displays a valid OMB control number. The valid OMB control number for this information collection is 0560-0204. The time requi2d to complete this inlormation colledion is <br />estimated to average f 5 minutes per response, induding the time for reviewing instiuctions, searching existing data souices, gathenng and maintaining the data needed, and <br />completing and reviewing the collection o/information. RE7URN THIS COMPLETED FORM 70 YOUR COUNTY FSA OFFICE. <br />