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<br />Af�davit of Affixture
<br />For a Mobile Home With a
<br />Nebraska Certi�cate of Title
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<br />Written consent for release of lien and cancellation of Certificate of Title from each lien holder must be attached to this
<br />AffidaviC. This completed Af�davit must be presented to the Designated County Of�cial, along with the Certificate of
<br />Title, in the county where the Certificate of Title was issued for cancellation of the existing Certificate of Title to occur.
<br />A filing fee is required per §33-1p9 �nd §33-112.
<br />Mobile Home Owner #1
<br />Name_�L�� L'� �O y� 1�-', K'�- 1 " ..,,_,_.....,—
<br />Address � �� C� � � ( ( 0�'' �� ,.,,_
<br />��� (� /� . y � _ p
<br />City, StateZip 'VV(�?aY 1�.(U-� I 1.�•,,,,�D 0�8�
<br />Mobile Home Owner #2
<br />Name � r
<br />Address 3 r I � S �
<br />City, State Zip ��,
<br />� I 16�' �o A-d.
<br />� � �� r, h.� � g�
<br />Attach additional Aflidavit(s) if more than 2 awners.
<br />Owner af real estttte
<br />❑ Leasing real estate
<br />Mobile Home Description: Year `� Make T Model N F�Clr D ¢ M
<br />Vehicle Identification Number ���-0�59� �,. ..,,,,,,. Title Number
<br />If two Vehicle Identification Numbers are present, an Aftidavit must be campleted for each number.
<br />Real �state Owner #1
<br />Name ,
<br />Address _ � ��_2�� • � ��� �l1 Q.�C,
<br />City, State, Zip, _�� �.�.���.._
<br />Real Estate Owner #2
<br />Name ti , _ / \ ���� ..._...--
<br />Address .� /� O �� � � ��' /� d�_,_...._
<br />City, State, Zip ��O � ��-[J�JG � �O O �
<br />�,
<br />Attach additional AfFidavit s if more than 2 entities are to be notifed.
<br />Copy of Notice of Cancellation shall be provided to all owners listed above and the following financial institution(s):
<br />�
<br />Name I�SL ' �� Name
<br />Address � J'�. S� �' ��1�ri J�Y �� Address
<br />City, State, ,Zip J ��,�i�� City, State, Zip
<br />Attach additional Afiidavit(s1 if more than 2 entities are to be notlfied
<br />1 of 3 Return to: ��' 7��
<br />Af�davit vf Affixture Fora Mobile Home With a Nebraska Certilicate of Title Rels Title 5/2006
<br />P&C Department
<br />1055 N. 115th St.
<br />Qmaha NE 6$154
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