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202007076 <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 />OtKK; ►l RabLE j <br />Printed Name of Mobile Home Owner <br />n. <br />it <br />rY�C 1 <br />Signature of file Home wne� rr <br />State of 0E -- <br />Sccr-rr- 4 aDLEy <br />Printe. Name of Mobile Home Owner <br />County <br />of <br />The foregoing signature of the affiant was ackno4ledged <br />before me this 1 --"day of .S mb-v,r , Gia . <br />Nota q;'be ignated County Official <br />GENERAL NOTARY - State of Nebraska <br />JEREMY D. MUELLER <br />My Comm. Exp. December 15, 2020 <br />Seal <br />ignature of • • a e Home 0 <br />State of <br />County of 4 l4 i <br />The foregoing signature of the affiant was acknowledged <br />before me this I7'day of —S rkc.wabe..- , ZOln <br />Nota 4y or,aesltgnated County Official <br />L. <br />r ----GENERAL NOTARY - State of Nebraska <br />it JEREMY D. MUELLER <br />My Comm. Exp. December 15, 2020 <br />Seal <br />For County Treasurer Use Only <br />County of filing- t Office of filing- t <br />Fee paid <br />Date of filing• <br />The County Treasurer shall forward the original to the Register of Deeds in the county where the reat°property is -,located <br />and provide copies to the Department of Motor Vehicles, County Assessor, owner and to each financial institution'lisied <br />on this Affidavit as notice of the cancellation of the Certificate of Title. <br />3 of3 <br />Affidavit of Affixture For a Mobile Home With a Nebraska Certificate of Title 6/2017 <br />