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Don R Richards (type the name of each Homeowner signing this A�davit] being duly sworn, on his or her oath state as follows: 2012U6�4� 1. Homeowner owns the manufactured home ("Home") described as follows: Used 0000 Atlantic Homes Division Champion 27 x 67 New / Used Year Manufacturer's Name Model Name or Number Length / Width 470170N1096A 470170N1096B Serial Number Serial Number Serial Number Serial Number 2. The Home was built in compliance with the federal Manufactured Home Construction and Safety Standards Act. 3. If the Homeowner is the first retail buyer of the Home, Homeowner is in receipt of (i) the manufacturer's warranty for the Home, (ii) the Consumer Manual for the Home, (iii) the Insulation Disclosure for the Home, and (iv) the formaldehyde health notice for the Home. 4. The Home is or will be located at the following "Property Address": - 325 Arapahoe Avenue Grand Island Hall NE 68803 Street or Route City County State Zip Code - 5. The legal description of the Property Address ("Land") is typed below or please see attached legal description: See Attached 6. The Homeowner is the owner of the Land or, if not the owner of the Land, is in possession of the real property pursuant to a lease in recordable form, and the consent of the lessor is attached to this Affidavit. 7. The Home � is � shall be anchored to the Land by attachment to a permanent foundation, constructed in accordance with applicable state and local building codes and manufacturer's specifications in a manner sufficient to validate any applicable manufacturer's warranty, and permanently connected to appropriate residential utilities (e.g., water, gas, electricity, sewer) ("Permanently Affixed"). The Homeowner intends t hat the Home be an immoveable fixture and a permanent improvement to the Land. 8. The Home shall be assessed and taxed as an improvement to the Land. Page 2 of 5