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202201202 <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 />t a[ t/o ef 14 vi+e <br />Printed Name of Mobile Home Owner <br />b-4 1 c? IJ 6-1 CAC c <br />Signature of Mobile Home Owner <br />State of I V`(—��, <br />pd <br />County of <br />kA <br />The foregoing si ture of the affiant was acknowledged <br />befoLe me this \Lay offL}-4ClA . <br />Notary or si nated <br />tQN ry g unty Official <br />GENERAL NOTARY - State of Nebraska <br />KARLY TRUJILLO <br />My Comm. Exp. May 26, 2023 <br />Seal <br />Printed Name of Mobile Home Owner <br />Signature of Mobile Home Owner <br />State of <br />County of <br />The foregoing signature of the affiant was acknowledged <br />before me this day of <br />Notary or Designated County Official <br />Seal <br />For County Treasurer Use Only <br />Office 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 />