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DA -7A NEBRASKA <br />DIVISION OF PUBLIC WELFARE <br />T?"N17,V.'AL <br />Certificate of Alward <br />Old Ade Assistance or, Blind Assistance <br />Type of Aid........ 914..A�e..Apviitance <br />........................................... <br />Name ............ T,.M!:k2..4 ........... ................................. Age ..... 90 ...... 1.11-1 No.AN!�1 A ... <br />Address........ ............ ilan .... I ....................... <br />....... 5 <br />Orilo-inal Paynient....1430*00 ...................................... Date ............... 11!!1- .......................... <br />Old Age Assistance: Legal description of real estate owned by recipient: <br />i Lot 5., Block 18j, Lambort's Addition <br />. ........... . . . .. <br />........................ ........................................ .-------------------------- <br />Sitinature of Payor t ite llireeor <br />State of Nebraska <br />County of ',Hall <br />Enter6d on Numerical Index and filed <br />for record in Office Register of <br />Deeds on 'the -------- day of <br />19 at <br />o'clock and - minutes --- q -,-M. <br />and 'recorded in Book ---------- of <br />C-1 <br />/?N,As t pag - 9, s <br />Register of Deeds <br />BY— — — — -Di-----Ut---- — — -------- <br />p y <br />