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N—_ — <br />(0cD <br />cn <br />- U o <br />NJ....B A S K <br />DEPARTMENT OF MOTOR VEHICLES <br />Affidavit of Affixture <br />For a Mobile Home With a <br />Nebraska Certificate of Title <br />rn <br />rn <br />r+l <br />Q <br />Let <br />rn <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 George M Schirmer a/k/a George Schirmer <br />Address 1608 S Eddy St <br />City, State Zip Grand Island, NE 68801 <br />Mobile Home Owner #2 <br />Name Marci R Schirmer <br />Address 1608 S Eddy St <br />City, State Zip Grand Island, NE 68801 <br />Attach additional Affidavit(s) if more than 2 owners. <br />❑■ Owner of real estate <br />❑ Leasing real estate <br />Mobile Home Description: Year 1988 Make Huntington Model Mobile Home <br />Vehicle Identification Number 479172N0539 Title Number 8J 015151 <br />If two Vehicle Identification Numbers are present, an Affidavit must be completed for each number. <br />Real Estate Owner #1 <br />Name George M Schirmer <br />Address 1608 S Eddy St <br />City, State, Zip Grand Island, NE 68801 <br />Real Estate Owner #2 <br />Name Marci R Schirmer <br />Address 1608 S Eddy St <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 Home Federal Savings and Loan Assn Name <br />Address 221 S Locust St <br />City, State, Zip Grand Island, NE 68801 <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 />6/2017 <br />