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DA -7A NEBRASKA <br />Rev. 7-65 DEPARTMENT OF, PUBLIC WELFARE <br />Is Jams Cook' Certificate of Award <br />226 K. 2nd Aid to the Aged, Blind or Disabled <br />Orwid 181wid, ?Wbr, N Nol"M--" .............................. <br />Name..... "Ka ... WMIM-E . ...................................................................................................... Age--- <br />Address... 7.04-R&.10ths ... .................................................................................. <br />city.............. .............. z .................................................. ...... SS No ................................................ <br />County ....... b.sa. ...................................................... Original Payment $ ...... Move ...... <br />Legal description of real estate owned by recipient: <br />An except 3 feet of Lot 9s Mock 200 Packer ,�, Barr 2nd Addition# <br />Grand Island. <br />........... <br />...................................................................................... . ........ ......... <br />signatum of Payee State &rector <br />0 0 3 8, 8 <br />OCT Z6 2 o5 PH '65 <br />STAT r OF NEB )w <br />Ty H LL 89 <br />ROSF ANN JAC?"EN: <br />Res. of 04"A <br />State of Nebraska <br />Counky cf I-11ali <br />Entered on Numerical Index and filed <br />for record in Cffice of Register of <br />Deeds on the 28th -- -- day of <br />— - <br />---- 0 ' ctQber. 19 65 at .-2--.. -- <br />o'clock and 05 minutes M. <br />and recorded 'in Book 1 3 of <br />_A <br />is tcr7�df <br />------------ <br />