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0 <br />I <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 />Printed Name of Mobile Home Owner <br />ature of Mobile Home Owner <br />State of 4) .era €'c( <br />County of /7 6 <br />The foregoing signature of th affiant was acknowled ed <br />before me this /7 day of ' <br />L �txu vi <br />Notary or Designated County Official <br />All owners must sign and signatures must be notarized. . <br />Seal <br />. irn �� A , ritz <br />Printed Name of M Home O ner <br />m(,c.e����l . t7r0 <br />Signature of Mobile Hume Owner <br />State of I c i cA 6L <br />County of <br />Hat) <br />The foregoing signature of t e affiant was acknowledged <br />before me this _La_ day of r-.0 <br />LEL <br />C.�. <br />Notary or Designated County Official <br />GENERAL NOTARY - State of Nebraska <br />CORI L. PERKINS <br />My Comm. Exp. April 13, 2021 <br />Seal <br />seeds in the county h <br />The County Treasurer shall forward the original to t he Register o <br />and provide copies to the Department of Motor Vehicles, County Assessor <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 6/2017 <br />