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• <br />202100712 <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 />3Rs4-i. Va. (a5zl�. <br />d Name ofMo/b' e Home Owner <br />/ <br />ignature of Mobile Home Owner <br />State of N <br />t <br />County of <br />The foregoing signature of the affiant was acknowledged <br />before me/ is 9 day of amu- <br />' <br />I / <br />/_ _i �- <br />Notary,. r Des 'a y at - <br />d County Official <br />GENERAL NOTARY - State of Nebraska <br />MINDY GILBERTSON <br />My Comm. Exp. May 16, 2024 <br />Seal <br />3es ca A. Va.I se(� <br />P <br />ted Name of Mobile Home Owner <br />4 <br />1 %a. zA---- <br />Si <br />of Mobile Home Owner <br />State of NIL/101/ )C_,.) <br />County of <br />1,6J.L <br />The foregoing signature of the affiant was acknowledged <br />before me his 2 day of <br />i <br />Not <br />or <br />D <br />ated County Official <br />GENERAL NOTARY - State of Nebraska <br />MINDY GILBERTSON Seal <br />My Comm. Exp. May 16, 2024 <br />For County Treasurer Use Only <br />Office of filing - <br />Fee paid: <br />County of filing. <br />Date 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 <br />6/2017 <br />