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DA -7A NEBRASKA <br />Rev. 7-65 DEPARTMENT OF PUBLIC WELFdRE <br />Certificate of Award <br />Aid to the Aged, Blind or Disabled <br />HH No ...... i10-3 F1 t1 -A2 .......................... <br />Name.......... ....: ':.... ...... ..........Age.....�7. <br />................................................................................. ........ . <br />Address................. .............................................................................i .........;--.tt........................... <br />ood...i. ve.. ` o )r. SS N .....?0>-1�-.� 0-i3 <br />City ...............=.. . <br />County..............�.................................................Original Payment 5.....Pi�t.,_........ Date .....—i_-05.................. <br />Legal description of real estate owned by recipient: <br />Lots 7'u 83 i?ii; 1.0., Orit;iriol' tarn of :aod 'Liv^r, i'.02 Co. <br />'leb3'. <br />1� <br />.............................................................................................. = V <br />SiFnntura o[ Pny�r Slate Director <br />003915 <br />State of Nebraska t <br />County of l.Iali f as <br />Entered on Numerical Index and filed <br />for record in �_ ffice of Register of <br />Deeds on the 28th __ __ day of <br />OCT Z8 2 07 PM '65 __0ctobor „ 1965. at .2_-__.__ <br />4URE <br />OR NEBRA ) o'clock and 07 minutes ..Ko& <br />HAL S8 and. recorded in Look __ ..: of <br />AL <br />Cts__p_==tai�C <br />ANN J EN; <br />DNdt <br />By----------- ------------------ <br />Fees �- no_ chg. Deputy <br />