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401106187 <br />Under penalty of law, the undersigned affirms that the information contained in this Affidavit of Affixture is true and correct and that <br />the above-described mobile home has been affixed to the real property described above. The undersigned hereby acknowledges that <br />this affidavit is made with the understanding that any person who misrepresents the information provided in this affidavit shall be <br />guiltyWperjury, a Class III Felony. <br />All owners must sign and signatures must be notarized. <br />Wi c-hap_i J_oe~ 6he. <br />Printed Name of Mobile Home Owner <br />7 2 <br />Signature of Mobile Home er <br />on n i~ ~a,4Printed Name of Mobile Howner <br />Signature of Mobile Home Own <br />State of ~ MUY <br />County of <br />The foregoing tore of the affiant wa acknowled e <br />f( <br />ore me thi y of - , <br />M ARRO <br />M <br />or Designated Coun~ ffi1 c~al - <br />Notary or Desi ated CountOfficia ~y 2012 Mary <br />. \ i ►~y <br />to o #X4 9 Corr <br />tiuctianan <br />For Designated County Official Use Only <br />County of filing. f~q L L Office of filing: ELiG%SST~dL o~ DENS <br />Date of filing: t' `l!/ Z31 <br />Fee paid: S S6 <br />The Designated County Official shall forward the original to the Register of Deeds in the county where the real property is <br />located and provide copies to the Department of Motor Vehicles, County Assessor, owner and to each financial institution <br />listed on this Affidavit as notice of the cancellation of the Certificate of Title. <br />A t <br />State of d y l <br />County of bw <br />The foregoing tune of the <br />before me this ~y of <br />3 of 3 <br />Affidavit of Affixture For a Mobile Home With a Nebraska Certificate of Title 5/2006 <br />