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202107425 <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 />R0 y D 1)01.2_0 <br />Printed Name of Mobile Home Owner <br />Signature of Mobile Home Owner <br />Th foregoing <br />ore me thi <br />re of th <br />day of <br />affiant w <br />s ackn wled d <br />Notary • Designated County Officia <br />GLNLRAL NOTARY - State of Neo aska <br />KARLY TRUJILLO <br />My Comm. Exp. May 26, 2023 <br />Seal <br />/74- r—R, 7 I wed/ <br />Printed Name of Mobile Home Owner <br />Signature of Mobile Home Owner <br />State of ReXkcc,\cV6 <br />County of <br />T e foregoing i [tre of t � affiant <br />be ore me this day of Il J <br />as ac s . led --d <br />Notary r Designate . County Official <br />GENERAL NOTARY - State of Nebraska <br />KARLY TRUJILLO <br />.�J My Comm. Exp. May 26, 2023 <br />Seal <br />County of filing:,'" 1 <br />For County Treasurer Use Only <br />Office of filin E 1 `i) <br />stU'�FI;ecco/ <br />s97Y <br />Date of filing <br />Fee paid: <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 6/2017 <br />