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Fill and Sign the Effective Financing Statement Formsnebraska Secretary of

Fill and Sign the Effective Financing Statement Formsnebraska Secretary of

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Amended Nebraska Effective Financing Statement EFS - 2 If EFS was f iled on or after July 1, 1999 provide: Secretary of State File Numbe r and Secretary of State Filing Dat e Said Effective Financing Statement is hereby amended to read as follows: 1. DEB TOR - IF INDIVIDUAL 2. ADDITION AL DEB TOR - IF INDIVIDUAL FOR SECRE TARY OF S TATE USE ON LY Name (Last, First, MI) Name (Last, First, MI) Mailing Address Mailing Address City State Zip Code City State Zip Code Unique Identifier Number (UIN) Unique Identifier Number (UIN) FILING FEE $10.00 3. ADDITION AL DEB TOR - IF INDIVIDUAL 4. ADDITION AL DEB TOR - IF ENTITY 5. SECURED PAR T Y Name (Last, First, MI) Name Name (Last, First) Mailing Address Mailing Address Mailing Address City State Zip Code City State Zip Code City State Zip Code Unique Identifier Number (UIN) Unique Identifier Number (UIN) 6. PRODUCTS SUBJECT TO SECURITY INTERESTS (See Instructions) A separate line must be used for each product, year and count y. The secured party has a security interest in the following farm products and proceeds of the Debto r. PRODUCT CROP YEAR COUNTY PRODUCT DESCRIPTION WHEN LESS THAN ALL OF PRODUCT IS COVERED BY SECURITY INTERES T. CODE N AM E CODE N AM E All amounts/quantities of the secured party's security interest; unless a specific crop y ear is indicated, this Statement is applicable for every crop year for the duration of this statement and any continuation thereof. Signature(s) of Debtor(s) below: Signature of Secured Party below: By To be filed with: Nebraska Secretary of State UCC Division PO Box 95104 Lincoln, NE 68509 Revised by the Secretary of State, 10 -2014 Reset Form Instructions AMENDED Nebraska Effective Financing Statement This form must be typed. Illegible forms will be returned without f iling. Provide information relating to Secretary of State Filing Date of EFS and Secretary of State Filing Number of EFS if filed on or after July 1, 1999. After you have f iled any EFS document with the Secretary of State’s Off ice, please provide only the Secretary of State ’s Filing Number for future document reference. Complete blocks 1 through 6 following instructions for completion of similar lines on EF S - 1 showing the Ef fective Financing Statement as Amended. Signatures of Debtor and Secured Party are required on this form: File at: Nebraska Secretary of State ’s Off ice Business Services Division PO Box 95104 Lincoln, NE 68509

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