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CASH CHECK �i-100 REFUNDS: CASH CHECK _ S QED HALL _ ::: NTY NE 2P?b 02 5 1 Li 1D26 AP` 21 A II: 2b ;a i i REGISTER OF DEEDS SA-1" Affidavit of Affixture N E B R SKA For a Mobile Home With a DEPARTMENT OF MOTOR VEHICLES Nebraska Certificate of Title Written consent for release of' lien and cancellation of Certificate of Title from each lien holder must be attached to this Affidavit. This completed Affidavit must be presented to the County Treasurer along with the Certificate of Title in the county where the real property is located for cancellation of the existing Certificate of Title to occur. A filing fee is required per §33-109 and §33-112. Mobile Home Owner #1 Name John L. 011vo Address 1529 N St Paul Road City, state zip Grand Island NE 68801 Mobile Home Owner #2 Name n/a Address n/a City, State Zip n/a Attach additional Affidavits) if more than 2 owners. Owner of real estate ❑ Leasing real estate Mobile Home Description: Year 2001 Make Bell's Custom Model MFGD HOME Vehicle Identification Number NEB10A28617 Title Number 03027080010 If two Vehicle Identification Numbers are present, an Affidavit must be completed for each number. Real Estate Owner #1 NameJuan L. Olivo a/k/a John L. Olivo Estate Address 1529 N. St Paul Road City, State, ZipGrand Island NE 668801 Real Estate Owner #2 Name n/a Address n/a City, State, Zip n/a Attach additional Affidavit(s) if more than 2 entities are to be notified. Copy of Notice of Cancellation shall be provided to all owners listed above and the following financial institution(s): Name Annette Santamarla Personal Representative Address 4004 Willington Ave Apt 1 City, State, Zip Chicago IL 60641 Name Na Address n/a City, State, Zip n/a Attach additional Affidavit(s) If more than 2 entities are to be notified 1 of 3 Affidavit of Affixture For a Mobile Home With a Nebraska Certificate of Title 6/2017