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DA -7A NEBRASKA <br />C-66 DIVISION OF PUBLIC WELFARE <br />Certificate of Award <br />Old Age Assistance or Blind Assistance <br />Type of Aid.......Gt �:..?. r. , a .................................. <br />N'ame..IYLnaiiatt,--•Ra r...U-4................................................... Age ..... Rum .....HH No..40!nI44G...U.......... <br />Address .... 211M. tr....... I:obrQunty......... 1 12 .......................................... <br />Original Payment ........................... a2.4..2.0....:. ............................. Date ............. a -1!4V3..................................... <br />Old Age Assistance: Legal description of real estate owned by recipient: <br />Lot b, Bloc]: 14, Soarff's Addition, !h11,County, Grand Isla nd, <br />I;obra s im . <br />......... <br />Signature of Payee Stato Director <br />State of Nebraska <br />County of ss <br />Entered on i.=crical Index and filed <br />for record in L ff:ce of Register of <br />Deeds on the � _ day of <br />- -- _ at --- 1� -- <br />o'ctcck t �-s`. ninti.es_.1-� SPA. <br />and recorded in Ecck42 --------- of <br />at ra.e __ 3, <br />F.eg-i ;ie: of Deeds <br />c By —_--- �CgJLtrj+ <br />Fees <br />