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Y' DEPARTMENT OF MOTOR VEHICLES <br />• <br />ta 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 6.; a ei L . e & <br />Address P. D . i `k cp <br />City, state Zip Q.)4 N 6 N 46 4 3 cI <br />5 Owner of real estate <br />rn <br />- <br />C <br />n z <br />=n <br />P= <br />\ \ <br />Affidavit of Affixture <br />Fora Mobile Home With a <br />Nebraska Certificate of Title <br />Mobile Home #2 , <br />/ <br />Name <br />City, State Zip <br />Attach additional Affidavits) if more than 2 owners. <br />❑ Leasing real estate <br />Mobile Home Description: Years ( Make C2m1)1(1() 100 <br />Vehicle Identification Number 0500 0 -f 7 On 51/55 A 8 <br />Model CP 070 C <br />Title Ntunber nee 06080003 <br />If two Vehicle Identification Numbers are present, an Affidavit must be completed for each number. <br />Real Estate Owner #1 <br />Name A l� acq L -H / )41 10 <br />Address ? • U • 6t)( cg-o 7 <br />cit state, zip t.. 4 50 it) td V • < V 3 `r <br />Real Estate #2 <br />Name /4 o.4d L X it:›taA <br />Attach additional Affidavit(s) if more than 2 entities are to be notified. <br />Address S !i dAtiii i n t 1 O, . p l � I <br />Cit state, zip aP, Q _ , (v _ �OSO l <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) ff more than 2 entities are to be notified <br />Name <br />Address <br />City, State, Zip <br />1of3 <br />Affidavit of Affixture For a Mobile Home With a Nebraska Certificate of Title <br />,t7 <br />cn <br />Address /J J1 hjY) ' a 0 <br />(go 10t2 <br />6/2017 <br />