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eIras1a <br />DM\ % % %// <br />Department of Motor Vehicles <br />Written consent for release of lien and cancellation of Certificate of Title from each Iien 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 #1 <br />Name ba ' e (_ R QUC , 11 <br />kddress / 0,c l` vJe+ Ze I Sic <br />City, State Zip ( r"CI t✓Cl, S /0 ikA OE 6 PM <br />Affidavit of Affixture <br />For a Mobile Home With a <br />Nebraska Certificate of Title <br />Mobile ome Owner #2 <br />Name Orr► p o S . RQ uC ti <br />Address 1 �J � � S • <br />City, State Zip r Ct rL-S 1Q ')o► <br />Attach additional Affidavit(s) if more than 2 owners. <br />Owner of real estate ❑ Leasing real estate <br />__ r e <br />M <br />OIRPMEIVI <br />odel <br />Mobile Home Description: Year <br />Make <br />Vehicle Identification Number 2 pO lM '1 1 o3 AB <br />If two Vehicle Identification Numbers are present, an Affidavit must be completed for each number. <br />Real Estate Owner #1 <br />Qale C Q tLctt <br />Address / ()S IA) ? +e ( ST. <br />City, State, Zip G rc 3 d .7. C 1 aA) 1 V _ Co Rec.)! <br />Name <br />Attach additional Affidavit(s) if more than 2 entities are to be notified. <br />Real Es to Owner #2 <br />Name ro S.1\-"c uC <br />Address / C) S v j ` - f z e ' 1 <br />City, State, Zip (c c� ZS tan) NE C W(01 <br />Cancellation shall be provided to all owners listed above and the follpwing fmancial institution(s): <br />Copy of Notice o <br />Name Pv <br />Address <br />City, State, Zip <br />Name <br />Address <br />City, State, Zip <br />C") <br />Attach additional Affidavit(s) if more than 2 entities are to be notified <br />1 of 3 <br />Affidavit of Affixture For a Mobile Home With a Nebraska Certificate of Title <br />C;) <br />CD <br />0 <br />--1 <br />m <br />Appendix A -35a <br />Title Number Q at 93 08 0 ©9 g <br />5/2006 <br />0 <br />