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A1111111111111 <br />l3v2liSed '1'9 <br />NEBRASKA <br />DEPARTMENT OF MOTOR VEHICLES <br />70 <br />m <br />-nn c <br />Z <br />rl <br />FmKir. <br />Affidavit of Affixture <br />For a Mobile Home With a <br />Nebraska Certificate of Title <br />t-: <br />co <br />CO <br />CD <br />_i <br />CO <br />CT) <br />CJl <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 Socorro Morales Duran <br />Address 1507 E 7th Street <br />City, State Zip Grand Island, NE 68801 <br />Mobile Home Owner #2 <br />Name Maria E. Perchez De Morales <br />Address 1507 E 7th Street <br />City, State Zip <br />Grand Island, NE 68801 <br />Attach additional Affidavit s) if more than 2 owners. <br />❑■ Owner of real estate 0 Leasing real estate <br />Mobile Home Description: Year 1997 Make Four Seasons Inc Model <br />Vehicle Identification Number FS204593 <br />Title Number 1916080022 <br />If two Vehicle Identification Numbers are present, an Affidavit must be completed for each number. <br />Real Estate Owner #1 <br />Name Socorro Morales <br />Address 1507 E 7th Street <br />City, State, Zip Grand Island, NE 68801 <br />Real Estate Owner #2 <br />Name Maria E. Morales <br />Address 1507 E 7th 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 Name <br />Address Address <br />City, State, Zip 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 />6/2017 <br />