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DA -TA. NMRABAA <br />Rev.: 7-55 . DEPARTMENT • OP P,IIBIdO,.WELFABE <br />Certi/ieate .-oJ ,Awdrd <br />slid to the Aged, Blind or Di.�bied <br />HH <br />!%m✓07*36-3967-U <br />pO-- <br />Name........ Age...... <br />] 8 <br />- Address......:.:.'.� i1b1~ ia�ks <br />:....P..t:.l.t.. <br />City e..........................:.................................. ........�VD&03'County................................... ..-:..........Original Payment $........---........Dae...... <br />Legal description of, real estate owned by recipient <br />144 2' Llock 51, Lair* !*field Village 3rd JLdd tion. <br />Signature of Payee <br />State Director <br />00015 <br />State of Nebraska j SS <br />County of Hall s <br />Grantor Entered on Numerical Index and filed 's <br />Grantee for record in Office of Reoistor o'r <br />Numencai..._...»...... Deeds on the...21st -----• a of <br />1.... 2.... 3.... 4.... January 19..1. at--:- <br />JAN Z I IU 08 �M ']I o'clock and ... 08minutes ..��--. M• <br />a d orded in Book . 3..._ <br />$ _, 0, war t g...:17��„. of <br />ST @' F NE Ct 7 <br />SE, r.n Jncaesep� ReTier of Deeds. <Rose Ann Jacobsen <br />t oo.de l/ By......._. ---• <br />Deputy <br />Fees ;no, cY.arge <br />