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2 5 7 4 <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 Ill Felony. <br />((7 ehrt L OLZvo 1p y D <br />1 i hwt kFG Jtid.'tG if O C. Ptreaos..c% <br />Printaid Name of Mobile Home Owner Rip !WWI . Printed Name of Mobile Home Owner <br />V o4 L. ?'+c <br />-�-�•.� rsonc. <br />Signature of Mobile Home Owner �eprr Signature of Mobile Home Owner <br />All owners must sign and signatures must be notarized. <br />State of 1-\\tro:4-. <br />County of C.. o dk <br />The foregoing signature of the affiant was acknowledged <br />before me this '1)t day of Apt i\ , "Loth. <br />Notary or Designated County Official <br />NUBIA CIZEK <br />t NOTARY J OFFICIAL SEAL <br />, PUBLIC Notary Public - State of Illi <br />STATE OF Commission Commission No. 1011289 1 <br />- - --1.4Comisissies-Es es Juse-9a. 8029iNr- <br />State of <br />County of <br />The foregoing signature of the aiiant was acknowledged <br />before me this day of <br />Notary or Designated County Official <br />Seal <br />County of filing: V1dlk <br />Date of filing L k2512a2 o <br />For County. Treasurer Use Only <br />Office of filing' 11I9 0% tLQ$s <br />Fee paid: V <br />The County Treasurer shall forward the original to the Register of Deeds in the county where the real property is located <br />and provide copies to the Department of Motor Vehicles, County Assessor, owner and to each financial institution listed <br />on this Affidavit as notice of the cancellation of the Certificate of Title. <br />3 of 3 <br />Affidavit of Affixturc For a Mobile Home With a Nebraska Certificate of Title 6/2017 <br />