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202403433 <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 />All owners must sign and signatures must be notarized. <br />'al\ 0 rr o,J <br />Printed Name of <br />Mobile Home Owner <br />Signature of Mobile Home wner <br />State of <br />County of <br />kfetetts& <br />4 -tai <br />The foregoing signature of the affiant was acknowledged <br />befor me this 1 day of i.c..t't—e_ , `aAa l <br />Notary or Designated County Official <br />jmouGENERAL NOTARY - State of Nebraska <br />ANN E. OTTMAN <br />My Comm. Exp. September 25, 2026 <br />Seal <br />Printed Name of Mobile Home Owner <br />Signature of Mobile Home Owner <br />State of <br />County of <br />The foregoing signature of the affiant was acknowledged <br />before me this day of <br />Notary or Designated County Official <br />Seal <br />or County Treasurer <br />The County Treasurer shall forward the original to the Register of Deeds in the, county where <br />and provide copies to the Department of Motor Vehicles, County Assessor, owner and to eac <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 />