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By signing below,Borrower accepts and agrees to the terms and covenants contained in this instrument and in any rider executed by Borrower and
<br /> recorded with this instrument.
<br /> (SEAL) ��i (SEAL)
<br /> Male Danie4 T e AKA Blake DItpe
<br /> (SEAL) (SEAL)
<br /> AKA Blak ope
<br /> ACKNOWLEDGMENTS
<br /> STATE OF a�
<br /> COUNTY OF ss.(Individual)
<br /> On thisJ day of before me personally appeared '6 6L 0 n i
<br /> a 1Cc3� �j Lei ,to be known to me to be the same whose name is subscribed to the foregoing
<br /> instrurncnt,and acknowledged that(he or she)signed and delivered the instruments as(his or her)free and voluntary act,for the uses and purposes
<br /> set forth.
<br /> My commission expires: uw)AL M SCt1MIDT
<br /> l HOTARY PUBLIC
<br /> STATE OF COLORADO �
<br /> '[ NOTARY ID 19984026657
<br /> MY COMMISS1
<br /> 0, CP�RES 0912412022 NOTARY PUBLIC
<br /> NOTE: The following stetement is made In accordance with the Privacy Act of 1974(5 USC 552a-as amended). The authority forrequesting the information identified on this form
<br /> is 7 CFR Part 764,7 CFR Part 765,the Consolidated Farm and Rural Development Act(7 U_S.C. 1921 at seq.),and the Agricultural Act of 2014(Pub.L. 113-79). The
<br /> information will be used to determine applicant/borrower ability to participate in and receive benefits under an FSA Loan Program. The information collected on this form may
<br /> be diseased to other Federal,State.Local government agencies,Tribal agencies,and nongovernmental entities that have been authorized access to the information by
<br /> statute or regulation and/or as described in applicable Routine Uses identified in the System of Records Notice for USDA7FSA-14,Applicant/Borrower. Providing the
<br /> requested Information is voluntary, However,failure to furnish the requested information will result in a determination that the applicantiborrower is unable to participate in
<br /> and receive benefits under an FSA Loan Program.
<br /> The provisions of carninet and civil fraud,privacy,and other statutes may be applicable to the information provided.
<br /> According to the Paperwork Reduction to the Paperwork Reduction Act of 1995.an agency may not conduct or sponsor,and a person is not required to respond to,a
<br /> collection of information unless it displays a valid OMB control number. The valid OMB control number for this inforrmation collection is 0560-0237, The time required to
<br /> complete this information collection Is estimated to average 30 minutes per response,including the time for reviewing instructions,searching existing data sources,gathering
<br /> and maintainigg,the data needed and completing and review' the collection of information. RETURN THIS COMPLETED FORM TO YOUR COUNTY FSA OFFICE.
<br /> In accordance with Federal civil rights law and U.S.Department of Agriculture(USDA)civil rights regulations and policies,the USDA,its Agencies,offices,and employees,
<br /> and inatihdfons participating in or administering USDA programs are prohibited from discriminating based on race,Color,national origin,religion,sex,gender identity(including
<br /> gender expression),sexual orientation,disability,age,marital status,family/parental status,income derived from a public assistance program,political beliefs,or reprisal or
<br /> retaliation for prior civil rights activity,In any program or activity conducted or funded by USDA(not all bases apply to all programs).Remedies and complaint filing deadlines
<br /> vary by program or incident.
<br /> Persons with disabilities who require alternative means of communication for program information(e_g.,Braille,large print,audiotape,American Sign Language,etc.)should
<br /> contact the responsible Agency or USDA's TARGET Center at(202) 720-2600(voice and TTY)or contact USDA through the Federal Relay Service at(800)877-8339.
<br /> Additionally,program information may be made available in languages other than English.
<br /> To file a program discrimination complaint,complete the USDA Program Discrimination Complaint Form,AD-0027,found online at
<br /> httD://www.ascr.usda.gov/complaint filing custhtm/and at any USDA office or write a letter addressed to USDA and provide in the letter all of the information requested in the
<br /> form.To request a copy of the complaint form,call(866)632-999Z Submit your Completed form or letter to USDA by.(1)mail:U.S.Department of Agriculture Office of the
<br /> Assistant Secretary for Civil Rights 1400 Independence Avenue,SW Washington,D.C.20250-9410,(2)fax:(202)690-7442;or(3)email:program.intakenjisda oov. USDA
<br /> is an equal opportunity provider,employer,and tender.
<br /> !Vote: Page 6 of 7 applies to entities only and will not be recorded for individuals.
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