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Affidavit of Affixture <br />NE BRAS K For a Mobile Home With a <br />DEPARTMENT OF MOTOR VEHICLES Nebraska Certificate of Title <br />rrt <br />� t <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 #1 <br />Name /;d -o P / Id/e- <br />b <br />Address Po. <br />City, State Zip / (/ , , /\.j /z 0 ?ft) <br />Mobile Home Owner #2 <br />Address P. t .Sox 11? <br />City, State Zip /PC/GLI N L ' 8' 870 <br />Name <br />Attach additional Affidavit s) if more than 2 owners. <br />Owner of real estate ❑ Leasing real estate <br />Mobile Home Description: Year / 993 Make ,/ e eie-cyo D cL Model <br />Vehicle Identification Number /8',2108191 8'p? (p 88.'77 N� <br />Title Number <br />I7v u b/e,t.0;d& <br />If two Vehicle Identification Numbers are present, an Affidavit must be completed for each number. <br />Real Estate Owner #1 <br />Name f)J it //u f 17 l e. <br />Real Estate Owner #2 <br />Address P. O • JJ o ®x G p� <br />City, State, Zip 4-1t /� T __ iv e-0 o <br />Name / p� <br />Address /9• C/ DX 116 <br />City, State, Zip JCL:t. AJ £ be0 /O <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 />1 of 3 <br />Affidavit of Affixture For a Mobile Home With a Nebraska Certificate of Title <br />612017 <br />