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200611316 DUSTIN B. JENKINS RACHAEL M. JENKINS [type the name of each Homeowner signing this Affidavit]; being duly sworn, on his or her oath state as follows: 1. Homeowner owns the manufactured home ("Home") described as follows: USED 1997 CHAMPION HOMES New/Used Year Manufacturer's Name Model Name or Model No. 042 X 027 Length x Width 05-97-568-2024A 05-97-568-2024B Serial No. Serial No. Serial No. Serial No. 2. The Home was built in compliance with the federal Manufactured Home Construction and Safety Standards Act. 3. If the Homeowner is the first retail buyer of the Home, Homeowner is in receipt of (i) the manufacturer's warranty for the Home, (ii) the Consumer Manual for the Home, (iii) the Insulation Disclosure for the Home, and (iv) the formaldehyde health notice for the Home. 4. The Home is or will be located at the following "Property Address"; 308 NORTH 2ND STREET, DONIPHAN, ,08ME6'fA, NE 68832 Street or Route, City, County, State Zip Code \-b.\\ 5. The legal description of the Property Address ("Land") is: LOTS THREE (3) AND FOUR (4), YATES SECOND SUBDIVISION, IN THE VILLAGE OF DONIPHAN, HALL COUNTY, NEBRASKA. TAX STATEMENTS SHOULD BE SENT TO: WELLS FARGO HOME MORTGAGE, P.O. BOX 17339, BALTIMORE, MD 212971339 6. The Homeowner is the owner of the Land or, if not the owner of the Land, is in possession of the real property pursuant to a lease in recordable form, and the consent of the lessor is attached to this Affidavit. 7. The Home [_1 is [_1 shall be anchored to the Land by attachment to a permanent foundation, constructed in accordance with applicable state and local building codes and manufacturer's specifications in a manner sufficient to validate any applicable manufacturer's warranty, and permanently connected to appropriate residential utilities (e.g., water, gas, electricity, sewer) ("Permanently Affixed"). The Homeowner intends that the Home be an immoveable fixture and a permanent improvement to the Land. ATTENTION COUNTY Page 2 of 5 RK: Th- instrument covers goods that are or are to become fixtures on the Land described herein e records where conveyances of real estate are recorded.