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DEPARTMENT OF MOTOR VEHICLES <br />CASH <br />CHECK 25t°C3 <br />REFUNDS: <br />CASH <br />CHECK <br />Rt.'„ <br />'.: k tlY <br />HALL C. NTY NE <br />MST T 2`;2=' 0 3 1.1 3 3 202{ P I I S <br />EG1S 3 <br />Affidavit of Affixture <br />For a Mobile Home With a <br />Nebraska Certificate of Title <br />Va <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 Robert Sherwood <br />Address 612 Suez <br />City, State Zip Cairo, NE 68824 <br />Mobile Home Owner #2 <br />Name <br />Address <br />City, State Zip <br />Attach additional Affidavit(s) if more than 2 owners. <br />0 Owner of real estate <br />0 Leasing real estate <br />Mobile Home Description: Year 2018 Make Champion Model Commonwealth <br />Vehicle Identification Number 02000PHA000711 A 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 Robert Sherwood <br />Address 612 Suez Street <br />City, State, Zip Cairo, NE 68824 <br />Real Estate Owner #2 <br />Name Brenda Sherwood <br />Address 612 Suez Street <br />City, State, Zip Cairo NE 68824 <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 />ci000 y4/82 <br />1 of 3 <br />Affidavit of Affixture For a Mobile Home With a Nebraska Certificate of Title <br />6/2017 <br />