Great Plains Appraisal, Inc.
1201 O Street, Lincoln, NE 68508 402-476-1144

P.O. Box 128, Nebraska City, NE 68410 402-873-5750

1343 Harre Lane, York, NE 68467 402-362-6062

Opr-Out Form

I, the undersigned, have reviewed the Confidentiality and Security Policy, Privacy Notice, and Opt-Out Notice provided by Great Plains Appraisal, Inc. provided in conjunction with providing appraisal services on the property located at

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The undersigned hereby exercises the right to have all personal information provided in conjunction with the appraisal not disclosed to third parties with the exception of any and all information pertaining to the real estate including income and expense information.

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Client Signature/Date

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for Great Plains Appraisal, Inc./Date