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DA -7A NEBRASKA <br />Rev. 7-e5 DEPARTMENT OF PUBLIC WELFARE <br />Certificate of Award <br />Aid to the Aged, Blind or Disabled <br />HHNO..... ........................... <br />Name........ i:.:;r.,: ::.L°y..._� a...........................................................................................................Age.f,..O .. <br />Address..................................................................................................................................................................... <br />City...........1:'� :ci..L .�nz'�...:���� zv: �.....................................SS No....................:...............:.................... <br />County ....... tin1.?....................................................Original Payment S ... r.L..g()...... Date ..... :9-1,—q............... <br />Legal description of real estate owned by recipient: <br />:�. l:o;. 19 ';l j;, 7, .`si, Lot 19 '-'.17te?.9 r 00d 4. !4a rsil,311 <br />/%ddltion 410 Wood. R!-�rr_rs :nll f:o.s IiGo:•R�t;.'t <br />....... .................. <br />Signature of I'aYee <br />- State Director <br />`J39� 3 <br />State of Nebraska j <br />County of lalt <br />Entered on Numerical Index and filed <br />for record 'in office of Register of <br />Deeds on the .28th_.... day of <br />UCI l� 01 <br />F. <br />` October„ 19.65_. at -2.-----. <br />A I NYBRAS o'clock and .._07 . minutes ---P.M. <br />Y,0 ALL And. recorded in Book __. 3. _ of <br />at age. .... <br />CSE)AtIH JACO NI -� <br />Res. of Goads _ <br />Register eeda <br />Bno chi-----------epu�-- .------- <br />Feesi---- -- <br />(� � 0 <br />