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MIAOW TO <br />Affidavit of Affixture <br />A <br />N <br />RP 4.-S 1. For a Mobile Home With a <br />DEPARTMENT OF MOTOR VEHICLES Nebraska Certificate of Title <br />CO <br />r\) <br />rV <br />c) <br />—c <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 />Mobile Home Owner #1 <br />Name Efren Mendoza <br />Address101 E 3rd <br />City, State Zip Alda NE 68810 <br />Mobile Home Owner #2 <br />Name Rosa Mendoza <br />Address 101 E. 3rd <br />City, State Zip Alda NE 68810 <br />Attach additional Affidavit(s) if more than 2 owners. <br />Owner of real estate ❑ Leasing real estate <br />Mobile Home Description: Year 2005 Make Dutch <br />Vehicle Identification Number DHIN42122F <br />Model Millennium <br />Title Number <br />If two Vehicle Identification Numbers are present, an Affidavit must be completed for each number. <br />Real Estate Owner #1 <br />Name -Y(In Menkw.- <br />Address � O E • 3Ytk <br />City, State, Zip <br />PcIda , Ne (A810 <br />Real EstatO`w,ner #2 <br />Name l Me 402lit-• <br />Address <br />101 E . 3 <br />City, State, Zip <br />P1.da,, NE boo <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 Name <br />Address Address <br />City, State, Zip 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 Horne With a Nebraska Certificate of Title <br />6/2017 <br />age <br />