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2016009 <br />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 />Z E5r/ ki7117;' <br />• ted Name of Mobile Home Owner <br />Signature of Mobile Home Owner <br />State of <br />County of <br />foregoing signature of the was acknowledged <br />before me this / day of -1--6 • , 00 . <br />Notary or Designated County Official <br />GEWERML NOTARY - Slate of Nebraska <br />DENICE R. KRUSE <br />My Comm. Exp. September 25, 2018 <br />All owners must sign and signatures must be notarized. <br />Seal <br />Printed Name of Mobile Home Owner <br />Signature of Mobile Home Owner <br />State of <br />County of <br />The foregoing signature of the affiant was acknowledged <br />before me this day of <br />Notary or Designated County Official <br />Seal <br />Office of filing- <br />For <br />ling <br />For County Treasurer Use O <br />Fee paid: <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 />