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201904365 <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 />All owners must sign and signatures must be notarized. <br />()LPYYO UYcIIIe2 UGre'ch <br />Printed Name of Mobile Home Owner <br />OGOV -tom 1t -GC ICES <br />Signature of Mobile Home Owner <br />State of \t <br />County of t C1 <br />The foregoing signature of the affiant was acknowledged <br />before me this_1'22... ; day of :� � , <br />.1) .1 i» C_�; � <br />Notary or Designated County Official <br />EMERAL NOTARY - State at Nebraska <br />SARAH M. WILES <br />L My Comm. Exp. June 19, 2023 <br />Seal <br />rel aYt a Ffdk6x C16 <br />Io <br />Printed Name of Mobile me Owner <br />Signature of Mobile Home Owner <br />State of , <br />County of<s <br />The foregoing signature of the affiant was acknowledged <br />before me this j day of 1 y� ; <br />Notary or Designated County Official <br />GENERAL NOTARY - State of Nebraska <br />SARAH M. WILES <br />My Comm. Exp. June 19, 2023 <br />J <br />AES <br />Seal <br />County of filing: <br />For County Treasurer Use Only <br />Date of filing: <br />Office of filing. <br />Fee paid: <br />The County Treasurer shall forward the original to the Register of Deeds in the county where the real property 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 Nebraska Certificate of Title 6/2017 <br />