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20/305015 <br />Under penalty of law, the undersigned affirms that the information contained in this Affidavit of Affixture is true and correct and that <br />the above - described mobile home has been affixed to the real property described above. The undersigned hereby acknowledges that <br />this affidavit is made with the understanding that any person who misrepresents the information provided in this affidavit shall be <br />guilty of perjury, a Class III Felony. <br />to e of Mobile Home Owner <br />ary or Designated County f ial <br />Printed Name of Mobile Home Owner <br />Si <br />n \de- E S'ecr <br />Name of Mobile Home L?wner <br />State of /v 4 raSlit <br />County of M/, <br />The foregoing signature of the affiant was acknowledged <br />before me t $ day of , ZQl <br />All owners must sign and signatures must be notarized. <br />Seal <br />Signature of Mobile Home Owner <br />State of <br />County of <br />The foregoing signature of the affiant was acknowledged <br />before me this day of <br />Notary or Designated County Official <br />Seal <br />Date offluin <br />For Designated County Official Use Only <br />Office of filing' '? /6 1 ' 1 le o F Y) g 5 <br />v <br />The Designated County Official shall forward the original to the Register of Deeds in the county where the real property is <br />located and provide copies to the Department of Motor Vehicles, County Assessor, owner and to each financial institution <br />listed on this Affidavit as notice of the cancellation of the Certificate of Title. <br />3 of 3 <br />Affidavit of Affixture For a Mobile Home With a Nebraska Certificate of Title 5/2006 <br />