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N <br />DEPARTMENT OF MOTOR VEHICLES <br />Mobile Home Owner #1 <br />Name Wilfred E. Jolkowski <br />Address 563 E 18th Street <br />City, state zip Grand Island, NE 68801 <br />0 <br />Name <br />n et <br />et <br />Q <br />0 <br />City, State Zip <br />Affidavit of Affixture <br />For a Mobile Home With a <br />Nebraska Certificate of Title <br />1 of 3 <br />Affidavit of Affixture For a Mobile Home With a Nebraska Certificate of Title <br />Mobile Home Owner #2 <br />Romaine A. Jolkowski <br />Address 563 E 18th Street <br />Attach additional Affidavit(s) if more than 2 owners. <br />Owner of real estate ❑ Leasing real estate <br />ry <br />CO <br />s <br />• <br />W 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 />Grand Island, NE 68801 <br />Mobile Home Description: Year 1975 Make Trinit Model <br />Vehicle Identification Number C E 10233331 <br />Title Number 00086041555 <br />If two Vehicle Identification Numbers are present, an Affidavit must be completed for each number. <br />Real Estate Owner #1 <br />Name Wilfred E. Jolkowski <br />Address 563 E 18th Street <br />City, State, Zip Grand Island, NE 68801 <br />Real Estate Owner #2 <br />Name Romaine A. Jolkowski <br />Address 563 E 18th Street <br />City, State, Zip Grand Island, NE 68801 <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 />Name <br />Address <br />City, State, Zip <br />Attach additional Affidavit(s) if more than 2 entities are to be notified <br />6/2017 <br />