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IV111.111111.11.1 <br />NEF3RASKA <br />DEPARTMENT OF MOTOR VEHICLES <br />Affidavit of Affixture <br />For a Mobile Home With a <br />Nebraska Certificate of Title <br />1 <br />au. 00 <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 />Mobihpme Owpe� #1 <br />Name � <br />Addres <br />Mo Home Owner #2 <br />Name k <br />Address Cir -A._ . <br />City, State Zip���\ �c- 1C� Ktiet3 City, State Zip <br />Attach additional Affidavit s) if more than 2 owners. <br />owner of real estate ❑ Leasing real estate <br />Mobile Home Description: Year <br />Vehicle Identification Number <br />odel CnLD O 1B4 <br />Title Number Nl ,aiaM <br />If two Vehicle Identification Numbers are present, an Affidavit must be completed for each number. <br />Real Estate Owner #1 <br />Name <br />Address <br />kl DivjruLut <br />coni-er i. Uot_ <br />City, State, Zip -cu" `ct- L.1L . L i "j t <br />Real EsPktti <br />toOwnenr'#2�,, n / , ,� J <br />a <br />Name lit- J tel/ V I 1 ( <br />Address Y L )Y1 LQ -X t 1. Vd <br />&l td <br />City, State, Zip W (.IBJ(UU�lrl'. 40d <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 <br />Address <br />City, State, Zip <br />Name <br />Address <br />City, State, Zip <br />Attach additional Affidavit(s) if more than 2 entities are to be notified <br />1 of 3 <br />Affidavit of Affixture For a Mobile Home With a Nebraska Certificate of Title <br />6/2017 <br />