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N EBR• K DEPARTMENT OF MOTOR VEHICLES N Affidavit of Affixture For a Mobile Home With a Nebraska Certificate of Title N rV CD CD C) -J CO ON 1N3WITJSNI 00 Written consent for release of lien and cancellation of Certificate of Title from each lien holder must be attached to this 2.1 Affidavit. This completed Affidavit must be presented to the County Treasurer along with the Certificate of Title in the county where the real property is located for cancellation of the existing Certificate of Title to occur. A filing fee is required per §33-109 and §33-112. Mobile Home Owner #1 Name Nikki R Bradley Address 106 Stellar St City, state zip Alda, NE 68810 Mobile Home Owner #2 Name Scott A Bradley Address 106 Stellar St City, State Zip Alda, NE 68810 Attach additional Affidavit s) if more than 2 owners. El Owner of real estate ❑ Leasing real estate Mobile Home Description: Year 1993 Make King Model 28x45 Vehicle Identification Number 05935147204 Title Number N0000798763 If two Vehicle Identification Numbers are present, an Affidavit must be completed for each number. Real Estate Owner #1 Name Nikki R Bradley Address 106 Stellar St City, State, Zip Alda, NE 68810 Real Estate Owner #2 Name Scott A Bradley Address 106 Stellar st City, State, Zip Alda, NE 68810 Attach additional Affidavit(s) if more than 2 entities are to be notified. Copy of Notice of Cancellation shall be provided to all owners listed above and the following financial institution(s): Name Home Federal Bank Name Address PO Box 1009 Address City, State, Zip Grand Island, NE 68802 City, State, Zip Attach additional Affidavit(s) if more than 2 entities are to be notified 1 of3 Affidavit of Affixture For a Mobile Horne With a Nebraska Certificate of Title 6/2017