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DEPARTMENT OF MOTOR VEHICLES <br />CASH <br />CHECK ef4 y co <br />�44317 F,a/a <br />REFUNDS: <br />CASH <br />CHECK <br />REC F,TED <br />HALL CC' '_'QTY NE <br />INST 2023 0 0 1 U 1 2023 FE6 i' P 1: 40 <br />Affidavit of Affixture <br />For a Mobile Home With a <br />Nebraska Certificate of Title <br />IO�ezJ�i 7i JL' <br />REGISTER OF DEEDS <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 a:4 1& <br />Address ()14 C1 w\ - p ‘ <br />City, State Zip�r�i;Pt�l� A°€ () sag <br />Mobile Home Owner #2 1 <br />\�` <br />Name <br />Address 2 -VA tar., fle 1 1 A V 42 -- <br />City, State Zip ,✓D»,Plna ✓ J fut. Ce i c 5 2- <br />Attach additional Affidavit(s) if more than 2 owners. <br />E Owner of real estate <br />❑ Leasing real estate <br />Mobile Home Description: Year I4? Make ,:trio 1JIiil Model a-, 4i <br />Vehicle Identification Number 74 Pt c2 6.1)a L Title Number NI mo�j- 7 4-C71q t <br />If two Vehicle Identification Numbers are present, an Affidavit must be completed for each number. <br />Real Estate Owner #1 <br />Namef6tt ,1/1j� e11c aiMki <br />Address Zl �k l ikk L) <br />City, State, ziplylnipl'& 1 N L � <br />Real Estate Owner #2 <br />Name kOt ‘c, ,c <br />Address 7j,� C wpb k) <br />City, State, Zips ,.pY‘12111 N t -C3.:' <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 />1of3 <br />Affidavit of Affixture For a Mobile Home With a Nebraska Certificate of Title <br />6/2017 <br />