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01 <br />N <br />febrasIa <br />LIMYE <br />O <br />2 8Th <br />11� <br />Mobile / home O ner #1 <br />Name . 51 r (?J l On J 1 hoixiD S o /'1 <br />Address <br />loa ZQ 7irn <br />City, State Zip Pfl d n_ 1) ( g g t Q <br />Vehicle Identification Number <br />Affidavit of Affixture <br />For a Mobile Home With a <br />Nebraska Certificate of Title <br />Mobile Home Description: Year q 9 9 Make <br />PP 9 goSA BINV vo 1 <br />1 of3 <br />Affidavit of Affixture For a Mobile Home With a Nebraska Certificate of Title <br />Attach additional Affidavit s) if more than 2 owners. <br />Owner of real estate ❑ Leasing real estate <br />Title Number <br />CO <br />�T7 <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 Home Owner # <br />Name „L�( - o Q Q I") man <br />� <br />Address to 0 1 (2_41 r r\ <br />City, State Zip ni aL.,.. ( i1 E.- to g O 10 <br />Model LD J)m lejLajj IL.. <br />If two Vehicle Identification Numbers are present, an Affidavit must be completed for each number. <br />Real Estate Owner #1 <br />Name <br />Address Address <br />Real Estate Owner #2 <br />Name <br />City, State, Zip City, State, Zip <br />Attach additional Affidavit(s) if more than 2 entities are to be notified. <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 />5/2006 <br />rn <br />z <br />—1 <br />m <br />A <br />is -' <br />,X25' <br />