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201103712 <br />IN WITNESS WHEREOF, Homeownerls? has executed his Affidavit in my presence and in the <br />presence of the undersigned witnesses o this �_ day of <br />, 0�� . <br />H meowner #1 (SEALI Witness <br />gp�mur.r� C Z RMAN <br />�-,.. <br />Homeo er #2 (SEAL) Witness <br />Homeowner #3 1SEAL) <br />Homeowner #4 iSEAL! <br />STATE OF �� I�, � V/� <br />COUNTY OF �-� �� <br />Witness <br />Witness <br />) <br />) ss.. <br />1 <br />On the ��� day of in the year �� � <br />me, the undersigned, a Notary Public in ar�d or said State, personally appeared <br />personally known to me or proved to me on the basis of satisfaEtory evidence to be the individual(s) <br />whose name(s) is(are) subscribed to the within instrument and acknowledged to me that <br />he/shelthey executed the same in his/her/their capacity(ies), and that by his/her/their signature(s► on <br />the instrument, the individual(s), or the person on behalf of which the individual(s) acted, executed <br />the instrument. <br />ota Signature <br />Notary Public, State of °� V`�. <br />My Commission expires: ��� <br />Official Seal: <br />GENERAL NOTARY - Stata o� Ne6raska <br />ELlZABET'hl q (,�q�pUNO <br />'" My Comm. Exp, March 2, 2013 <br />�J���`�h ,�4�` �r�un� <br />Notary Printed Name <br />Qualified in the County of L� <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 estete are recorded. <br />Page 4 <br />NMFL # 7111 (MAHA) Rev2/4/2008 <br />