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DA -7A NEBRASKA <br />Rev. 7-65 DEPARTMENT OF PUBLIC WELFARE <br />Certificate of Award <br />Aid to.the Aged, Blind'or Disabled' <br />Hit No..4q.-;60.71.—.D1 .............................. <br />Name ...... W991.j ... C406] ..... ..... ...... .... .. ..... <br />M ............................................................. .... .................................... Age.5.3 <br />Address........ 19% ... 4, .................................... ­ ............................................................................................. <br />City..............Grand. ... W .... W ...... 1.8-1 ......... *.4rG.01M ................----...:.....SS No..............----..:............... •... <br />County........:Ilan .....................Original Payment 09.?�!;P ........ Date;P�!!!�� ................ <br />.......... <br />Legal description of real estate owned by recipient: <br />Lot 6, Block 11, Evans AddlUon,, GrwW Island, <br />............................ : .............................................. ............................................................................ <br />Signature . o if ... Payee State Director Xi. <br />0 0 4 2 <br />State of Nebraska <br />County of Hall <br />Entered on Numerical Index and filed <br />--for record in Office of Register of <br />NOV 19 9 36 <br />L-ece- cn [lie .19th day of <br />No4ember <br />— --.. - i7 AM 165 ---- 131. 9 <br />8T FNB SKN o'c:c a-,.-: -36 *-- rli!."Mtes -.At-M. <br />OF L anct rcecr"'Iccl in neo k ----3 ______`.of <br />-- /VfM <br />-"TA o—V- AtjWJ VOSMZ <br />By--------- -------— <br />Fees $M0-9bMe Deputy <br />