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201103712 RATHLEEN C ZII�RMAN [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 1"Home") described as follows: IISED 2002 PATRIOT 068 X030 New/Used Year Manufacturer's Name Model Name or Model No. Length x Width CV3289AIN CV32898IN 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 af 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": 437 E LOIIP RIVER RD, SAINT LIBORY, HOWARD, NE 68$72 Street or Route, City, County, State Zip Code 5. The legal description of the Property Address ("Land") is: �OT ONE V RYAN—ZINIl�RMAN SUSDIVISION SALL COUNTY� NEBRASRA. TAX STATEMEN'PS SHOULD BE SENT TO: WELLS E'ARGO HOME MORTGAGE, P.O. SOX 11701, NETi�iRR, NJ 071014701 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 [ ] is [ ] 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 1e.g., water, gas, electricity, sewer) {"Permenently Affixed"). The Homeowner intends that the Home be an immoveable fixture and a permanent improvement to the L.and. ATTENTION COUNTY CLERK: This instrument covers goods that are or are to become fixtures on the Land described herein and is to be filed for record in the records where conveyances of real estate are recorded. � �, Z- Page 2 Initial: � NMFL # 7171 (MAHA► Rev 2/4/2008