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DA -7A RUM" <br />Rev. 7-86 KA, <br />DEPAUTDEPARTMENTNEMIROF P"UBLIC WELFARE <br />• Oertificate of. Award <br />Aid to the Aged, Blind or Disabled <br />HH No ...... ha -69U -.41-1"o <br />Name ........... e <br />........................................................... Ag <br />Address .... . ... ... "ja .................................. . <br />" ........ ****"*"** ........ * ..... i% ........... <br />City .......... OMMO .. SWIM. 04 ... 940 M. ..M............. -..............SS ko .......... 5 ............... <br />County..........111M .......:.........•-.....................-:........ Original Payment $.98.49P ........ Date ... ?-I-& MA <br />Legal description of.reall estate, owned by recipient: <br />South )A Lot 59. %ook. 5# Ors girl Tom of nand Island <br />S1.9natu,re of Payee <br />........... .................... <br />0 2 9* 7 <br />S'nte of Nebrar,Ica Grantor <br />County of Flaii es Grantee—Z—, <br />Enttrcd on Numerical lade= r-nd filed Vurnerical <br />for record in Offica of peg;8jez. of 1_ 2_ 3— 4— <br />b—da on die ----- 3-Oth - day of <br />41 <br />o'clock- and__ 6-�- <br />M,—"Utcz JUL 30 1 <br />644d rcCorded in Boot- - ----- 3-__ cf STATE OF NZEIRASKA) SS <br />Ctf COUNTY OF HALL <br />Rose Ann Jacobsen 'A C —SE f.;:7, 4 J A C. 0 S 6 rt N: <br />R .3 Rdl� of Vaeds <br />By <br />F. D�Cputy <br />