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DA -7A NEBRASKA <br />Rev. 7-6e ' DEPARTMENT OF PUBLIC WELFARE <br />Certificate of Award. r <br />•, Aid to the .Aged, Blind or Disabled 10.670-A2 <br />;J(;x, >tdnn HH No ................................. <br />Name........................ ................... ....,................................................................... ................................... Age ............ <br />City .................. .............SS No ..................... 2..... <br />_"�"' <br />County ..............:.......................................................Original Payment $...... z.:..... Date ... ,ro............................. <br />Legal description of real estate owned by recipient: <br />'*rt of the ,N l'; )f :;' of uee. no %- p. no Rge 90 nau <br />Co.# ?Mobra, <br />.................................................................... ........... <br />Signature of Payce - (T State Director. <br />Str.tc of t:ebrasl_n <br />as <br />Crun,-1 of <br />;"r.tercd o:i e.u:nerical Index and filed <br />for recor y in 1—M"Ce cf Register of <br />fNOVDee -'L on t:.c 15th day of- <br />NOV <br />---- November i96 -. a+ J ------ <br />1 9 <br />`J 13 - S� a'cla::, as 13- "-. m ales Ae__Iti'1. <br />STAT9 OF NIS irA) <br />;d :e o:d d in 1=cok- ------- of <br />CoUNTY MA t ) ss Ctf.of y72 _ t p- -$3-- -• <br />ROSE At "q JAC0� <br />/8EN; --- '- --"'-'- <br />/Res. of Oda D�Rem ate of Deeds <br />By-- -._-- <br />Deputy <br />fees :� T10 C,�a�ge <br />