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m <br /> nn -I <br /> - r c l • f^�1 PO rn <br /> IVY ^A 0 �-, CD <br /> NMI c _' a <br /> 0 m a - N <br /> Nm∎ c „ !--' <br /> cfl ` --.] c r t ---I <br /> W <br /> O C <br /> { m <br /> ro cn <br /> �' I -. —+9 <br /> fi r ) <br /> N c,,) W Z <br /> Affidavit of Affixture " .: <br /> ______Hot........„tbraska For a Mobile Home With a <br /> Nebraska Certificate of Title o 0 <br /> Written consent for release of lien and cancellation of Certificate of Title from each lien holder must be attacheu 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 Cody Owner#1 Mobile Home Owner#2 <br /> Name L od y I n rl Cl d1 Name <br /> Address '110 5o q Brici). .t R[X Address <br /> '))City,State Zip A.p y 1'1 a �0 D�3 Z City,State Zip <br /> Attach additional Affidavit(s)if more than 2 owners. <br /> C Owner of real estate ❑ Leasing real estate <br /> Mobile Home Description: Year f q 11 Make C haY f)%OY1 Model <br /> Vehicle Identification Number 07 i?asgt"i b`i? Ab Title Number /5/9OQQ0v(o2 <br /> If two Vehicle Identification Numbers are present,an Affidavit must be completed for each number. <br /> Real Estate Owner#1 Real Estate Owner#2 <br /> Name Cod y /- wtnav Name <br /> Address Stk.() Sn C( toci p L t, Address <br /> City,State,Zip 1Q ken i\e— I (0S4 3Z 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 listed above and the following financial institution(s): <br /> Name Name <br /> ddress Address <br /> City,State,Zip City,State,Zip <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 6/2014 <br />