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1-bTA <br />DIVISION OF P <br />VISPUBLIC WELFARE <br />Certificate- of Award <br />Old -<Age -Assistance -or Blind Assistance <br />1ji. of Aid' Aseietanoe` <br />........... ... <br />OriginalPayment .......... 9P.W9+....................................................care.....:......................! -- ................ <br />Old Age Assistance: legal description of real estate owned by recipient: <br />* Lot l,0 Blook 368, Original Tmn of Grand Islande <br />.................. <br />......... <br />.... <br />State Director if <br />Signature of Payee <br />65 <br />tate of Nebraska <br />Ccua.y of Mali as <br />1 C ca Nurnzncal Index and filed <br />for racord in ':Ica of Registrar of <br />L'eecs en ,.Ie---------th__ day of <br />January__ ii)_.�4_ at �_---- <br />o'cfoc', and; -__ 01r_-- mi,nukes.a_-N. <br />a►:d r.:cc:Lzd, in Ecol ___ _ of <br />Ctf. of _Awards at pag:a-- s-A�-4 <br />-----]r.G,.ist ��Deedg - Register . <br />By------ <br />Fees $- <br />Ra—Cbarg eputy <br />