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inaiA, <br />DIVISION OF NEBRASKA <br />VISUBT. O WELFARE <br />Cettif icate of Award <br />Old` -Age Assistance -or Blind -:Assistance <br />�dTYPe Aso.......estan <br />Name.... .............................. ..... Age ... il1..:.. -.HN No.a4 1 �1� ......... <br />Address.WQW..UVoie ..Ball; Nabr.ai ea....................County ............ <br />Original Payment......" Atko.............................. ......................Date.:......... ............. ..._.... <br />Old Age Assistance: Legal description of real estate owned by recipient: <br />Aores to 198j of SeCU= 149 South dackam <br />% ............ ..............tr .. <br />f f <br />Uv <br />......................... ............ �... �....... ..... r .. <br />Signature of Payee State Director �!� <br />State of Fdeb :,r1ca 1 ' <br />Ccur y c: <br />fc: r3_.D:ci• iI "f ie _ „ s'.c: of <br />L.C. cxa i -- cj'�Y of <br />I' az D:: ads <br />BY <br />Deputy <br />Fees $ � . <br />