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DA -7A NEBRASKA <br />u-57 DIVISION OF PUBLIC WELFARE. <br />Certificate of .'tF.N'r.;WAL Azuard - <br />Old -Age - Assistance or Blind -Assistance <br />Type of <br />.................................... <br />Nam. SO=. u.........HH No..hQ-?9.1Q-A2. ... <br />..................... ... .........1 <br />Nall <br />Address..201..hl&..e7a doo.. rrand..lalam4...P:ehr...County........................�..Q.............................. <br />OriginalPayment ...... t,,51.%Q................. ...................................... Date ................ a-1..-................................. <br />Old Age Assistance: Legal description of real estate owned by recipient: <br />Lot 10i Block 2$p Packer and Barr 2nd Addition to Orand Ielande <br />Signature of Fnyce <br />A-11 <br />�tafie of r<cb-mcka <br />CSL �:y c: H it ss <br />lir.:.se•� _.. i'._�tcr=�_az ine-em and f:ed <br />fc. r -_-=d <br />s. ffegista: of <br />------- /_ :::-- day cf <br />19_ 3_ at _ ? <br />c'ctc•-:x wv_'! ---- <br />Wlu �a:l.ai a•�Ct� 2a 13,3,- -- v, <br />By__—�__---------__— __-- <br />L��uiy <br />Fees $---`� <br />...................... <br />State Director 77L.. <br />