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DA7A c NEBRA$SA 1 <br />Rev. 7-66 DEPARTMENT .OF PUBLIC WELFARE <br />Certificate of Award- <br />" Aid to the Aged, Blind or Disabled ' <br />:. <br />o 40-09642-3"0 <br />1111 N. !..... <br />Age....61..0Name.........RQMM-RIAM.9..................................................................._....................................- <br />.. <br />Address...... 9M.e..%# ...: <br />city .. �ar,eaa s u e ..... ........... ... 3 ..... <br />county ..... ..:IM :........ ......... ...:::.:..........Original Payment $. .....Date...... ............. <br />legal description: of real_ estate owned by recipient: <br />ilia► 33siit fto Fr Lot 4 and Vo $9.6 rt, Fro Lot 3i <br />B,,ec_,-� Fr* M To L06erte Addition* ezd H. 43 !'te. <br />$o Lot iy 8r• — to: Foam, dddSttan to Qr and 181 Md. <br />&ba* 10 r ✓�ws <br />. .. .....:........Sig ._.......of........ ..... ..itat.... ire . <br />Signature of PayeeState Director <br />0008Th <br />'State of Nebrnslsa . <br />County of Hall Index end filed <br />Grant -or Entered on Nnmescal <br />GT4�.�/nteo for reccrt3 in tiffke of Regietie� of. <br />- -i c23 L � � the 13th-__ day of <br />March_ -9-.70-_ 'at <br />►Fit <br />pp 7 <br />Mal{ IJ d 59 AAI's Yro 6�r Com% 21 .tt --- crOf <br />- <br />a � AX� <br />sCtf . of Awa at p�rA �iL6,.8'Lt:r pfL✓ <br />_ / .. <br />CiE r J/tC0i3S ' <br />f UOtldy- <br />Dep t7. - <br />Fees no _charge <br />