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202107424 <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 />Ro `((I _Dc,%; v4_, t ( <br />Printed Name of Mobile Home Owner <br />Signature of Mobile Home Owner <br />State of ¥\lt c-\ ' <br />County of <br />The foregoing si na of th affiant w s ac wled <br />b fore me this_, ay of <br />\11 <br />' ti/' <br />l\ <br />otary r Designated County Offici 1 <br />GENERAL NOTARY - State of Nebraska <br />KARLY TRUJILLO <br />My Comm. Exp. May 26, 2023 <br />Seal <br />azx 421) /3 - <br />Printed Name of Mobile Home Owner <br />Signature of Mobile Home Owner <br />The foregoing s tre oft affiant was ackno led ed <br />bef e me this day of —t� . <br />No ary Dj igrtated County Officia <br />t GENERAL NOTARY - State of Nebraska <br />KARLY TRUJILLO <br />My Comm. Exp. May 26, 2023 <br />Seal <br />For County Treasurer Use Only <br />County of filing: H( <br />Date of filing: " I I ) <br />24 <br />t cti, i W' ti.elistcr <br />Fee paid az <br />Office of filing <br />tiedo <br />The County Treasurer shall forward the original to the Regis er 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 />