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' c <br />4 4, Y2- P <br />co _ Z <br />rn ' T <br />(i -C% <br />t0 r 3 <br />C <br />I IN I= M■N■ <br />-e <br />m <br />-n <br />C <br />= z <br />n ® <br />m cn <br />X_ <br />i <br />Affidavit of Affixture <br />For a Mobile Home With a <br />Nebraska Certificate of Title <br />cr <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 Home Owner #1 <br />Name Ramos,Cruaf, Sr <br />Address 831 E Capital Ave <br />City, State Zip Grand Island, NE 68803 <br />Owner of real estate <br />Mobile Home Owner #2 <br />Name Minerva M Ramos <br />Address 831 E Capital Ave <br />Attach additional Affidavit(s) if more than 2 owners. <br />City, State Zip Grand Island, NE 68803 <br />❑ Leasing real estate <br />Mobile Home Description: Year 1997 Make Champion Model Mfgd Home <br />Vehicle Identification Number <br />05976891468AB Title Number E 1281618 <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 />Attach additional Affidavit(s) if more than 2 entities are to be notified. <br />Name <br />Address <br />City, State, Zip <br />Copy of Notice of Cancellation shall be provided to all owners listed above and the following financial institution(s): <br />Name Home Federal Savings & Loan Assn <br />Address 221 S Locust St / PO Box 1009 <br />City, State, Zip Grand Island, NE 68802 <br />Attach additional Affidavit(s) if more than 2 entities are to be notified <br />Name <br />Address <br />City, State, Zip <br />1 of 3 <br />Affidavit of Affixture For a Mobile Home With a Nebraska Certificate of Title <br />7/2012 <br />cz rrt <br />rri <br />C7 <br />W � <br />a) co <br />� C <br />rn <br />z <br />z <br />0 <br />