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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 I11 Felony. <br />r 0( -"n0 I JO S <br />Printed Name of Mobile Home Owner <br />goxvotoe"-1 <br />Signature of Mobile Home Owner <br />E <br />The foregoing si ture of the iant was acknowledged <br />before me this day of , 013 . <br />`----.3\*12-4'6;L" n� C2(._ <br />Notary or Designated County Official <br />GENERAL NOTARY • State of Nebraska <br />SHEILA K. AXFORD <br />My Ooaxtt xp. Oct 30, 2013 <br />All owners must sign and signatures must be notarized. <br />Seal <br />ro 0d < �2. • bari-vyla <br />Printed Name of 1Vlobile Home Owner <br />201305528 <br />ile Home Owner <br />The foregoing siwpre of the ant was acknowledged <br />before me this day of _— ,°Z O (3 . <br />Notary or Designated County Official <br />GENERAL NOTARY • State of Nebraska <br />SHEILA K. AXFORD <br />My Comm. Exp. Oct 30, 2013 <br />3 of 3 <br />Affidavit of Affixture For a Mobile Home With a Nebraska Certificate of Title <br />Seal <br />County of filing <br />Date of <br />Us <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 MotorYehicles, County Assessor owner and to each financial institution <br />listed on this Affidavit as notice of the cancelle on o - e Certificate of Title. <br />5/2006 <br />