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CD <br />Affidavit of Affixture <br />For a Mobile Home With a <br />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 '7 , f ;;) <br />Address 101 iny'r' 4' PQ. ,r» +g4 <br />City, State Zip A /ril 4W 10 <br />Attach additional Affidavit(s) if more than 2 owners. <br />Owner of real estate ❑ Leasing real estate <br />Mobile Home Owner #2 <br />Name <br />Address <br />City, State Zip <br />Mobile Home Description: Year <br />Vehicle Identification Number <br />Make Model <br />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 7 2 1 - 5 -() Yl / <br />Address go/ !J Yr -k AO. Ao l c t <br />City, State, Zip r /t q . (o n ) <br />Real Estate Owner #2 <br />Name <br />Address <br />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 <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 />1 of 3 <br />Affidavit of Affixture For a Mobile Home With a Nebraska Certificate of Title <br />r .1 <br />C..) <br />612014 <br />