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elcs <br />202204244 <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 />�r Menao- i <br />Printed ame of Mobile Home Owner <br />All owners must sign and signatures must be notarized. <br />eosA Men'Leat ' kA Vos6a <br />Printed Name of Mobile Home Owner <br />Signature of Mobile Home Owner <br />State of Ne,briAsSick. <br />County of I -6U <br />The foregoing sig.nature of the affiant was acknowledged <br />before me this day ofYiniP , h1R <br />Ca,( t 7 <br />Notary or Designated County Official <br />XENEFIALNOTARY-State of Nebraska <br />STACIE NOVAKOWSKI <br />*Comm. Ftp. August 27, 2025 <br />Seal <br />4 men <br />Signature of Mobile <br />• <br />ACA 'auk. <br />me Owner <br />State of 14.\O <br />County of \caj,.\\ <br />The foregoing signature of the affiant was acknowledged <br />before me this — day +f ,SOS \ Si , <br />Notary or ignated County Official <br />Seal <br />For County Treasurer Use Only <br />IyoT <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 />