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202006917 <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 />Geoe e_ vfl Srrne r <br />Printed Nam f Mobile Home Owner <br />Signature of Mobile Home S wner <br />State of <br />County of 1TCi 11 <br />eir <br />Printed Name of Mobile Home a wner <br />1) 1I ,i.�. <br />i <br />Signature of Mobile Home Owner <br />State of <br />County of /4 a 1' <br />The foregoing signature of the affiant was ackno ledged The foregoing signature of the affiant was acknowledged <br />before me this 1l ft." day of Selo Ie v k b "f , C .20 before me this li 14' day of. icsi.b , 71) 47 <br />Notary or Zesigi ted County Official <br />GENERAL NOTARY- State of Nebraska <br />JEREMY D. MUELLER <br />'' My Comm. Exp. December 15, 2020 <br />Seal <br />Notary or bZesigr%ted County Official <br />A <br />GENERAL NOTARY - State of Nebraska <br />JEREMY D. MUELLER <br />My Comm. Exp. December 15, 2020 <br />Seal <br />For County Treasurer Use Only <br />Office' Of filing. <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 />