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DA -7A NEBRASKA <br />Rev. 7-65 DEPARTMENT OF PUBLIC WELFARE <br />Certificate of Award <br />Aid to th6'Agbd, Blind or Disabled <br />HitNo...... .......................... <br />Name ...................... M11Wb8th <br />.............................................................................. .................................... Age.... <br />Address ..................'03..14•-- WaMo <br />City ........................Grand an1s' 1— a- n- <br />....... ..................... ............................................. SS <br />a.....i...NO..i* <br />.......... ............ <br />County ...................H.............Oriqinal Payment ,.W.......Date..... <br />................. <br />Legal description of real estate owned by recipient: <br />Packer & Dam 2nd Add. Lot 10# Block 28 <br />Signature of Payee <br />3 <br />... ...... <br />................... / <br />t <br />Stnte Ir tor <br />State of Nebraska <br />Ccunty of '.-;at,' as <br />Entered ozi f-urnerical Index and filed <br />for record iz; . ff.ce of register of <br />heeds &nt A - e 28th .. day of <br />OCT Z8 05 PM '65 ---- -- er i a - 65 at <br />BT T F NE KA) o'clock and 05 rn.nutes -F.. K <br />F NAL and recorded r in. Book -3 of <br />RCO Ctf-,-.0f--AVji0 apage,3.1-- <br />By-------------------------------- <br />Fees. t -no --eh Deputy r <br />