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Mobile Home Owner #1 <br />Name Curtis DeVore <br />Address boil 7 S St <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 #2 <br />Name Nancy DeVore <br />Address ( -' (f .7 s, C <br />City, State ZipLJ1a� P_� City, State Zip <br />Attach additional Affidavit(s) if more than 2 owners. <br />Owner of real estate <br />❑ Leasing real estate <br />1 of 3 <br />Affidavit of Affixture For a Mobile Home With a Nebraska Certificate of Title <br />Mobile Home Description: Year 1999 Make Oak Park 11' <br />model OR094 <br />Vehicle Identification Number 4799094013303ABC 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 Curtis Devore <br />Address <br />City, State, Zip <br />Real Estate Owner #2 <br />Name Nancy DeVore <br />Attach additional Affidavit(s) if more than 2 entities are to be notified. <br />Address <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 />6/2014 <br />