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201109394 <br />CCC-297 (0&18-04) <br />Page 2 of 2 <br />IN WITNESS V,yHEREOF, the undersigned p es hereto have xecuted this instrument <br />this (h) l e� '�" �� day of (i) �.� L � vY-. �� f , 0) � � (year). <br />if a corporation: <br />PATHWAY BANK f/k/a THE STATE BANK OF CAIRO <br />(k) Name of Corporate (Mortgagee) {9lvner�} * <br />B G��F�� �� 6 : re� <br />([) Dudy uthorized Offtc <br />/� � � <br />(m) Title <br />CORPORATE <br />SEAL <br />"Mortgagee" includes holder of any type of real estate lien. <br />*Delete "Mortgagee" or "Owner." <br />� <br />(p) STATE OF �.e �(�` � S �G �G. <br />(g) COUNTY OF �� � } ss. ACKNOWLEDGMENT: <br />On this (r) ��_ day of (s) �r ���j�.. P'' in the ear (t) �, be ore � o e e Q <br />me, the undersigned, a Notary Public in and for said State, personally appeared (u) ° s, t r �; r��L f � <br />personally known to me or proved to me on the basis of satisfactory evidence to be the individual(s) wh se name(s) is (are)�'� L'�'� <br />subscribed to the within instrument and acknowledged to me that he/she executed the same in his/her/their capacity (ies), <br />and that by his/her/their signature(s) on the instrument, the individual(s) or the person on behalf of which the individual(s) <br />acted, execute the instrument. <br />�.1�TINM-S�teO�Nsbre�e SE ) �-� L�i e�C!�' <br />I� t.�WAKMARE � <br />�� ����Zpy (v) Notary Public <br />" My commission expires (w) � � �� S <br />(MM-DD-YYYY) <br />The /olfowing statement (s made !n accordance wifh the Privacy Act oI 1974 (5 USC 552a) and the Pepenvork Reduction Ad o/ 1995, as amanded. The authoriry lor requestir <br />tlte lolfowing 1nPoimaBon !s 7 CFR Pad 1436 and the Commotlity Credlt Corporatlon Charter Ad, 5 USC 719 at. seq. The in/ormafion will be used to tletermine eligibility �or C( <br />financing /or Iarm, staage and drying equipment. Fumishing the requestad informaBon is voWntary, howevar, wifhout it CCC finarning under fha program cannof be prowtlad. <br />Failure to /umtsh the requested JMormatlon will result !n deniaJ o/ CCC flnandng urMer thls program. Thls ln/ortnatlon may be provided to other agenGes, IRS, Departmant of <br />Justice, or otBer State and Federal !aw enPoroement agandes, and !n rasponse to a court magishate or administradve tdbunal. The provisions ol c6minal and ciNl Iraud statuh <br />induding 18 USC 286, 287, 371, 641, 651, 1001; 15 USC 714m; and 31 USC 3729, may be appltcable to t6e !n/ortnadon proWded. <br />AxoMing to the Paperworic ReducBon Ad of 1995, an agency mey not condud or sponsor, arW a person 7s not iequlred ro respond fo, a crollection ollnlorma6on unleu rt <br />dlspfeys a vaUd OMB con6o/ number. The valid OMB conWl numl�rPor this i�amatlon cro/!ec(ion !s 0560-0204. The Bme required to wmpfete this INormatlon wlfection is <br />estlmated to average 15 minutes perresponse, induding the dme lorreviewing lnstiucHons, searching existing data sources, gathanng and maintaining fhe data needed. and <br />compledng arM reHewing the co11ec0'on o/lnformaUon. RETURN THIS COMPtETED FORIN TO YOUR COUNTY FSA OFFICE. <br />R R WNER) <br />,� <br />� � _ <br />YCE A PACKER (OWNER) <br />