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ICJ 1 0 2 9 2 3 <br />Affidavit of Affixture <br />NE BRINS-KA <br />CASH <br />-w <br />CHECKC <br />REFUNDS: <br />CASH <br />CHECK <br />REX) JEt7 <br />HALL COUNTY NE <br />1015 ,1U - 02 - <br />WOLD <br />l EGISTER OF DEEDS. <br />Written consent for release of lien and cancellation of Certificate of Title from each lien holder must be attacar9 <br />hed 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 />For a Mobile Home With a <br />DEPARTMENT OF MOTOR VEHICLES Nebraska Certificate of Title <br />Mobile Home Owner #1 <br />Name Pocvv'- -v <br />Address <br />OG 9 t.-'1vo-vv t \ Are - <br />City, State Zip S - •qcmj'L N gs' 73 <br />Mobile Home Owner #2 <br />Name <br />Address <br />City, State Zip <br />Attach additional Affidavit(s) if more than 2 owners. <br />Owner of real estate <br />❑ Leasing real estate <br />Mobile Home Description: Year / 9 1 Make A� i D TV <br />Vehicle Identification Number <br />Model 9 G v©0 2, 5 <br />Title Number 4 6 <br />If two Vehicle Identification Numbers are present, an Affidavit must be completed for each number. <br />63 AJ <br />Real Estate Owner #1 <br />Name ` u.C.Y.- - c\iWv.3 '\ VsT <br />Address V. tJ nks.c <br />City, State, Zip J�k U�, t/`-t�. 1 `� k. o g '7 S <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 "'��\f'Q 6 `\'~.�lb C\V\ Name <br />Address 6 Q' ( 1 5-0-7 <br />City, State, Zip \Vf v^S.. <br />Address <br />4�j� .Y t� ►`�' k;i (3 ^•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 Horne With a Nebraska Certificate of Title <br />6/2017 <br />