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cri <br />00 <br />PARTMENT OF MOTOR VEHICLES <br />CASH / <br />CH CK i.Ye/.1 <br />/14/A %%YT 01117 <br />'EF NiS: <br />CASH <br />CHECK <br />11 HH25 0 I b <br />Affidavit of Affixture <br />For a Mobile Home With a <br />Nebraska Certificate of Title <br />.tZ <br />RECORDED <br />HALL ``"'� :.,,,.,I T Y NE <br />7015 APR -LI A1a 51 <br />°r'YdOL <br />RFG1STER OF DEEDS <br />28(P <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 />NameTRI CITY METERS, INC. <br />Address 210 E FRONT ST <br />City, state zipALDA, NE 68810 <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 />Make MAGNOLIA MOBILE HOMES Model WOODHAVEN <br />Mobile Home Description: Year 1982 <br />Vehicle Identification Number GDGENE388212486AB 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 <br />Address <br />City, State, Zip <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 Name <br />Address <br />City, State, Zip <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 />