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Under penalty of law, the undersigned affirms that the information contained in this Affidavit of Affixture is true and correct and that <br />the above - described mobile home has been affixed to the real property described above. The undersigned hereby acknowledges that <br />this affidavit is made with the understanding that any person who misrepresents the information provided in this affidavit shall be <br />guilty of perjury, a Class III Felony. <br />f Mo ra <br />Pr te N. <br />GENERAL NOTARY - State of Nebraska <br />MINDY GILBERTSON <br />My Comm. Exp. May 16 201a <br />1 y o WYQvic -e, <br />Printed Name of Mobile Home Owner <br />Signature o,-' obile Home Owner <br />State of M tiov (4 <br />County of .1 <br />The foregoing signature of the affiant was acknowledged <br />before me this 2f) t. day of r i ( , 2 015 <br />() <br />Not. or Desi ted County Official <br />All owners must sign and signatures must be notarized. <br />Seal <br />Signat <br />e Owner <br />e Owner <br />State of &s l< <br />County ofA�(�f <br />The foregoing si a of the want was acknowledged <br />before me this '' — day of <br />Notary of DesignatEe( County Official <br />201502990 <br />Lovavic, <br />1 l , 2-6/ . <br />GENERAL NOTARY - State of Nebraska <br />MINDY GILBERTSON <br />My Comm. Exp. May 16, 2016 <br />Seal <br />For County Treasurer Use Only <br />County of filing Office of filing- <br />Fee paid: <br />Date of filing: <br />The County Treasurer shall forward the original to the Register of Deeds in the county where the real property is located <br />and provide copies to the Department of Motor Vehicles, County Assessor, owner and to each financial institution listed <br />on this Affidavit as notice of the cancellation of the Certificate of Title. <br />3 of 3 <br />Affidavit of Affixture For a Mobile Home With a Nebraska Certificate of Title 6/2014 <br />