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IEras a <br />A <br />N.) — vl <br />C <br />W A <br />0 �� JC Pi <br />CS) 7 til " <br />]D)MV <br />Department of Motor Vehicles <br />Mobile Home Description: Year Make <br />8 A IDSLO <br />Vehicle Identification Number <br />1r <br />et <br />I l i <br />Affidavit of Affixture <br />For a Mobile Home With a <br />Nebraska Certificate of Title <br />Mobile Home Owner #2 <br />• o ▪ -i <br />C , C D <br />- CD <br />N O - Tt <br />r — - - <br />f 7t <br />r— <br />Ca <br />Written consent for release of lien and cancellation of Certificate of Title from each lien holder must be attached to this <br />Affidavit. This completed Affidavit must be presented to the Designated County Official, along with the Certificate of <br />Title, in the county where the Certificate of Title was issued for cancellation of the existing Certificate of Title to occur. <br />A filing fee is required per §33 -109 and §33 -112. <br />Mobile me Owner #1 <br />Name IAh Sthw('Q l ciPaoset. Name Jaf1lte *)e. ht.di le Qr <br />2 . � S I A ddress Sgt. t I <br />Address _1 A' <br />City, State Zip ritn.d land nic llt &W City, State Zip (� ria. 144 IYt (&6I <br />Attach additional Affidavit s) if more than 2 owners. <br />ill Owner of real estate ❑ Leasing real estate <br />onn <br />i <br />— <br />Model <br />If two Vehicle Identification Numbers are present, an Affidavit must be completed for each number. <br />Real Estate Owner #1 <br />Jan ice g 6e . u cwt. <br />4Z .l� <br />Address ' o c <br />13 • `J <br />City, State, Zip ankft CS Ss 114.4A d E j <br />Name <br />Real Estate Owner #2 <br />Attach additional Affidavit(s) if more than 2 entities are to be notified. <br />Name <br />Address <br />City, State, Zip <br />Copy of Notice of Cancellation shall be provided to all owners listed above and the following financial institution(s): <br />Name <br />Address <br />City, State, Zip <br />Attach additional Affidavit(s) if more than 2 entities are to be notified <br />Name <br />Address <br />City, State, Zip <br />1 of <br />Affidavit of Affixture For a Mobile Home With a Nebraska Certificate of Title <br />Title Number O D 1 co / <br />5/2006 <br />5' <br />