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ZI•L001.Z0Z <br />• • <br />U) <br />co <br />Affidavit of Affixture <br />NEB-RA&KA For a Mobile Home With a <br />DEPARTMENT OF MOTOR VEHICLES Nebraska Certificate of Title <br />-:, <br />N <br />CD <br />ru <br />Q <br />N) <br />I—� <br />CD <br />CD <br />—a <br />I✓ <br />N <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 Justin R Valasek <br />Address 515 Saturn St <br />City, State zip Alda NE 68810 <br />Mobile Home Owner #2 <br />Name Jessica A Valasek <br />Address 515 Saturn St <br />City, State Zip Alda NE 68810 <br />Attach additional Affidavit(s) if more than 2 owners. <br />❑■ Owner of real estate <br />0 Leasing real estate <br />Mobile Home Description: Year 1999 <br />Vehicle Identification Number LP P9627 <br />Make Lincoln Park Mobile Homes Inc Model DGATO7ODBF <br />Title Number N0001113431 <br />If two Vehicle Identification Numbers are present, an Affidavit must be completed for each number. <br />Real Estate Owner #1 <br />Name Justin R Valasek <br />Address 515 Saturn St <br />City, State, Zip <br />Alda NE 68810 <br />Real Estate Owner #2 <br />Name Jessica A Valasek <br />Address 515 Saturn St <br />City, State, Zip Alda NE 68810 <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 & Loan Assn Name <br />Address 221 S Locust St <br />City, State, Zip Grand Island NE 68801 City, State, Zip <br />Address <br />Attach additional Affidavit(s) if more than 2 entities are to be notified <br />1 of 3 <br />Affidavit of Afhxture For a Mobile Home With a Nebraska Certificate of Title <br />6/2017 <br />ON IN]WITh1SNI SY 03U31N3 <br />