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N<Ge :4a. <br />DMV <br />0 <br />Department of Motor Vehicles <br />Name. <br />( . Address <br />.ty, State, Zip <br />Mobile Home Owner #1 <br />l <br />Name i\ L aVcA 0(\ Oe \ 'Q . ‘c) G C <br />- `a ddress 4' - g Aro , vckkrio�. A\)_??' . . <br />..aty, State Zip. b. (Ofl(l \6■1A t T73 n <br />>w <br />rt <br />t <br />X_ <br />Affidavit of Affixture <br />For a Mobile Home With a <br />Nebraska Certificate of Title <br />1 of <br />Affidavit of Affixto a For a Mobile Home With a Nebraska Certificate of Title <br />rri <br />ca <br />• <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' #2 <br />Name \k ( <br />Address 6 M N . P Ya e ANte <br />City, State .Zip • ( c 15\00(0. N `G . Os-go? <br />Attach additional Affidavit(s) if more than 2 owners. <br />0 Owner of real. estate Leasing real estate <br />Appendix A -35a <br />Mobile Home Description: Year VII Make beer <br />Vehicle Identification Number (v . M 110 (-b 5 Lf O \ d 5 <br />Model `R=Ln 5 . <br />Title Number <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 <br />City, State, Zip <br />Real Estate Owner #2 <br />Name <br />Address <br />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 fisted 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 />5/2006 <br />rn <br />N g <br />l-+ <br />co <br />c� <br />cc) <br />t?? <br />Q <br />0 <br />