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DA -7A 'NEBRASKA <br />DIVISION OF PUBLIC NIMINARE <br />Certificate of zlivard <br />Old Age Assistance or Blind Assistance R7 '-:,.'.'AT <br />Type of Aid ....... 7-01d A -o Arsi�;t.,.i cc <br />Name .......... l r <br />Caro1 <br />...... ** ......... ........... Age ....... 8-1 ....... HH No.10=1152mll .......... <br />Address ....... Pa -EE Vora3ka Hal.], <br />......................... County ............... ............................... <br />Original Payment. ........ <br />...... ........................................................... Date .................................................................. <br />Old Age Assistance: Legal description of real estate owned by recipient: <br />T-ot 3, 131ock 29 11ideon Additionq Donipha-il 77obrarka <br />. ................. <br />................................................................. <br />1Rnnture <br />of Paye <br />Stab Director <br />