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m <br />m <br />C <br />z <br />rr n <br />2 <br />n n <br />m Ili <br />r1 ]: <br />� I <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 />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 Brion G Lorance <br />Mobile Home Owner #2 <br />Name <br />Sara L Lorance <br />Address 1419 Po St Address 1419 Poplar St <br />City, State Zip Grand Island, NE 68801 City, State Zip Grand Island, NE 68801 <br />Attach additional Affidavit(s) if more than 2 owners. <br />© Owner of real estate ❑ Leasing real estate <br />Mobile Home Description: Year 2001 Make CHIEF INDUSTRIES Model BELLAVISTA <br />Vehicle Identification Number NEB 10- A28595 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 Brion G Lorance <br />Address 1419 Poplar St <br />City, State, Zip Grand Island, NE 68801 <br />Real Estate Owner #2 <br />Name Sara L Lorance <br />Address 1419 Poplar St <br />City, State, Zip Grand Island, NE 68801 <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 Home Federal Savings & Loan Assn Name <br />Address 221 S Locust St / PO Box 100 Address <br />City, State, Zip Grand Island, NE 68802 <br />City, State, Zip <br />Attach additional Affidavit(*) if more than 2 entities are to be notified <br />6/2014 <br />rn <br />—1 <br />Fri <br />rn <br />c <br />CD > <br />co <br />f—' <br />Cf1 <br />NC <br />ct <br />CDC <br />CDC <br />O� <br />