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201705159 <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 />a i &/ Lt Pi nete. <br />Printed Name of Mobile Home Owner <br />Signatur f Mobile Home Owner <br />State of ( \13 <br />The foregoing si _a . e of the <br />before me this d day of <br />Designated County Offi <br />All owners must sign and signatures must be notarized. <br />was acknowled <br />• <br />VQ Al , Cc. D. H1 "Tiller <br />Printed Name of Mobile Home Owner <br />ljama ilel6u2A3 <br />Signature of Mobile Home Owner <br />State of <br />County of <br />The foregoing signature of the <br />bef me this 4 of <br />Notary or Designated County Official <br />GENERAL NOTARY - State of Nebraska <br />CARINA MORENO- PERALES <br />My Comm. Exp. April 13, 2020 <br />t was acknowledged <br />v'LO <br />Seal <br />JuunumitimtnttttttiiIOFFiIIAL minirmimmuui_ <br />4sr''' y Notary Public, State Of West Virginia 2E. Seal <br />JUDITH F MAYS <br />V' .f 380 Auburn Ct <br />_ ' Charles town, wv zo414 <br />Intiitrtrirt1i 41111 ilNHiHq 101011111 111 III <br />County of filing <br />Date of filing: <br />Irreasserer Use Only <br />Office of filing: <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 <br />6/2017 <br />