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MWPM� <br />DEP BOE PUBLIO �➢ELFASY+ <br />Oettificate'of At6ard <br />A to the Aged, Blind or Disabled <br />& HH He ....................... <br />Name....... ..................................................................................................... Age ....93-- <br />Address..- <br />...93..Address .. .............................................................................................................................. . <br />, ls� ................................... SS No ..... 50.q ........ <br />city ......... ergoit .. mands-abIr .... w .......... W3 <br />County ..... B@U ...................................................... Original Payment $ ..... V*Q* ........ Date ... ............... <br />Legal description of real estate owned by recipient: <br />fto Seati= 13a U 99 washivgUin <br />Sign <br />of Payee <br />u <br />State of Nebraska <br />ss <br />County of Hall <br />Entered on Numerical Index and filed <br />for record in Ufice of. Register of <br />26th d of <br />en t: -66 <br />JUL 2 G July 19 -- at ----------- <br />o'clocii and 03. minutes *6TAC? Nag as <br />' 11 7L1 * <br />H4 and recorded in hook --.-3 ------- of <br />tf t—qK. <br />6 411 JA <br />01 VWCW <br />By------------ ----------------- <br />Fees <br />---------------- <br />Fees I Peputy <br />