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Address <br />c �. <br />2 <br />Mobile tome Owner #1 I <br />• <br />Name t 1Gi �' i rn 1 c&4 i / f <br />1 <br />' OS - SI <br />City, State Zip okht 4k 1 d 0 /v <br />Affidavit of Affixture <br />For a Mobile Home With a <br />Nebraska Certificate of Title <br />1 of 3 <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 />— n <br />t . <br />C7y <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 County Treasurer along with the Certificate of Title in the <br />county where the real property is located for cancellation of the existing Certificate of Title to occur. <br />A filing fee is required per §33 -109 and §33 -112. <br />Mobile Hom Owner #2 <br />Name ` J , l\ <br />Address jD} ) / <br />City, State Zip n/ /a 6 gg/ C <br />Mobile Home Description: Year 400 I Make D1 4-1 /hu.(C2_ Model <br />Vehicle Identification Number R I004 '104 Title Number <br />If two Vehicle Identification Numbers are present, an Affidavit must be completed for ach number. <br />Real E a te Owner #1 <br />Name UO >J l l \ c6P,1 2r 1' <br />Address IQC) S S03 I lit Y!1 1 <br />City, State, Zip A )C) C Me 1p, i io <br />Real Esta Owner #2 P) <br />Name j ell' a T .Y1 Le/ <br />616, l c dattAr) <br />Address <br />Attach additional Affidavit(s) if more than 2 entities are to be notified. <br />Cit State, Zip &Oda , O <br />Copy of Notice of Cancellation shall be provided to all owners listed above and the following financial institution(s): <br />Name Name <br />Address Address <br />City, State, Zip City, State, Zip <br />Attach additional Affidavit(s) if more than 2 entities are to be notified <br />7/2012 <br />rn <br />CD <br />f--a t1 <br />c: <br />CD <br />CID <br />Ci <br />.e;l <br />