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-4 <br />co <br />Mobile Home Owner #1 <br />Name Jeremy L. Straatman <br />Address 14375 S. Alda Road <br />City, State Zip Wood River, NE 68883 <br />m <br />m <br />C <br />Z <br />rn 2:0 <br />t'1 <br />V1 � <br />X 2 <br />Affidavit of Affixture <br />For a Mobile Home With a <br />Nebraska Certificate of Title <br />Attach additional Affidavit(s) if more than 2 owners. <br />Owner of real estate <br />Mobile Home Owner #2 <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 />❑ Leasing real estate <br />m <br />-1 <br />rn <br />m <br />0 <br />6/2014 <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 Description: Year 1999 Make Colt Mobile Home Model 68 -64x28 HA2009 <br />Vehicle Identification Number HA00657 A/B MO 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 Jeremy L. Straatman.? <br />Address 14375 S. Alda Road <br />City, State, Zip Wood River, NE 68883 <br />Real Estate Owner #2 <br />Name <br />Address <br />Attach additional Affidavit(s) if more than 2 entities are to be notified. <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 <br />Address <br />City, State, Zip <br />Attach additional Affidavit(s) if more than 2 entities are to be notified <br />Name <br />Address <br />City, State, Zip <br />