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DA -7A NEBRASKA <br />u-67 DIVISION OF PUBUO WELFARE <br />Certificate of Award <br />Old, -Age• -Assistance -or --Blend Assistance <br />Type of Aid ARe..AealetattCe .. <br />Name ...... Hjjj g �...ThczagkEa............................................Age HH Holk"?9bien ..... <br />Address... rhas... s 10121 1s .....County .............................. <br />Original Payment ....... 55.00....... .... Date..::..... y2..� ..:...._... <br />Old Age Assistance: Legal description of real estate owned by recipient: <br />Lot 29 Block 3, VIIIA90 of Dtmiph=9 <br />...........::...................................................................................... <br />.................Sig ................ Stato Director <br />...- Siannturc of Payea � <br />v <br />4 L1 <br />State of Nebraska l E$ <br />Ccun!Y of hall J <br />Iird t<r�on C�u^terical Index and <br />r' of <br />for re o:a in �,ed <br />s'fice of �t_eg' c <br />s on the �------- day <br />of <br />j.. co-- at `f_--- <br />o'clock d __-------- <br />an minute> __-- o f <br />ar,d re�corded in colc _ -------- <br />Register of Deeds <br />----------------- ' <br />BY -------- jZeputY <br />Fees $--- <br />