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201807000 <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 Il] Felony. <br />#e -- Printed <br />Printed Name of Mobile Home Own r <br />Signature o e Home Owner <br />State of N b ra_s,�4 <br />County of aC. [ ! <br />All owners must sign and signatures must be notarized. <br />Printed Name of Mobile Home Owner <br />Signature of Mobile Home Owner <br />State of 1 v C), -t sL 4 <br />County of C a_-/ <br />The foregoing si nature of the affiantwas acknowled e The foregoing st na ure of the affnianp was acknowledge <br />before me this / day of ©(� before me thio day of Q L a / <br />esignated County Official <br />GENERAL NOTARY - State of Nebraska <br />AMY J. CONKLIN <br />"'* My Comm. Exp, December 29, 2020 <br />Seal <br />Nota' o[ Designated County Official <br />GENERAL NOTARY - State of Nebraska <br />AMY J. CONKLIN <br />My Comm. Exp. December 29, 2020 <br />Seal <br />County Treasurer Use On! <br />County of filing: <br />Date of filing: <br />The County Treasurer 'sha11forward the original to the Register of Deeds in the county where the realproperty 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 Ncbraska Certificate of Title <br />6/2017 <br />