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<br />200611316 <br /> <br /> <br />IN WITNESS WHEREOF, Homeowner(s) has executed~is Affidavit in my presence and in the <br />~ce of th~nderSigned witnesses on this (5' day of <br />l,?n1:;r , ~Dlf . <br /> <br />Witness <br /> <br />Witness <br /> <br />Homeowner #3 (SEAL) <br /> <br />Witness <br /> <br />Homeowner #4 (SEAL) <br /> <br />Witness <br /> <br />STATE OF ,A/J 1/1-< sttv <br /> <br />COUNTY OF fwi <br />.~ <br />On the 15' ~ <br /> <br />l <br />l sS.: <br />) <br /> <br />day of ~fR)rllx.f <br /> <br />in the year :Jmip <br /> <br />b , a t>J9tary Public in and for aid St <br />(, <br />pe sonally known to me or proved to me on the basis of satisfactory eVidence to be the individual(s) <br />whose name(s) is(are) subscribed to the within instrument and acknowledged to me that <br />he/she/they executed the same in his/her/their capacity(ies), and that by his/her/their signature(s) on <br />the instrument, the individual(sl, or the person on behalf of which the individual(sl acted, executed <br />th~s/ument. I!J <br /> <br />.....>11/lAA/lt1- ~ftt/lA-- ,) h;Uui~ 1!I1I,dkzi7.:z~ <br />Notary Signature Notary Printed Name <br /> <br />Notary Public; State Of---fi.JiJ 1/1../; iL1. Qualified in the County of /bR <br />My commission expires: 5'.( { I {)-OJ 0 <br />Official Seal: <br /> <br /> <br />GENERAL. NOTARY. Slate of Nebntska <br />SHAUNA CHRISTENSEN <br />- My Comm. Exp. May 1, 2010 <br /> <br />ATTENTION COUNTY CLERK: This instrument covers goods that are or are to become fixtures on the Land described herein <br />and is to be filed for record in the records where conveyances of real estate are recorded. <br /> <br />Page 4 of 5 <br />NMFL # 7111 (MAHA) Rev 02/06 <br />