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INST 20Z3 028b <br />Affidavit of Affixture <br />NEBRASKA For a Mobile Home With a <br />CASH Pea _to <br />CHECK • <br />REFUNDS: <br />CASH <br />CHECK <br />�1.... \.•� ..i i... E.J <br />HALL s; ';i NE <br />2023 Ju -.cj P 2: 58 <br />KRISii WOW <br />REGISTER OF DEEDS <br />DEPARTMENT OF MOTOR VEHICLES Nebraska Certificate of Title <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 /K IA <br />Address t Z-1 8 01/44—= tt A v <br />City, State Zip H N C -S Q s- 6 89' a <br />Mobile Home Owner #2 <br />Name <br />Address <br />City, State Zip <br />Attach additional Affidavit(s) if more than 2 owners. <br />lgrowner of real estate <br />0 Leasing real estate <br />Mobile Home Description: Year AC' '1 Make A0Vi Iet.R.42— ft 5-S Model rnoT< UE, t f� g3 <br />Vehicle Identification Number A b L$ 0 1 A 014 841111r 13 Title Number N DO 03 09-1 3 L17 <br />If two Vehicle Identification Numbers are present, an Affidavit must be completed for each number. <br />Real Estate Owner #1 <br />NameINS f - f� <br />Address 2t Off( 1•+ C,Fk LIFO R N i klf_ <br />City, State, Zip 1 G v t,.1NG5 I1E (0810 <br />Real Estate Owner #2 <br />Name <br />Address <br />City, State, Zip <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 />1 of 3 <br />Affidavit of Affixture For a Mobile Home With a Nebraska Certificate of Title <br />6/2017 <br />