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This is a True Copy of Certificate Originaly Issued .Ne iC V�ndemo e r Director of Assistance DEPARTMENT NEBRASKA BOARD OF CONTROL OF ASSISTANCE AND CHILD WELFARE N° 4 DECLARATION OF OWNERSHIP OF REAL ESTATE City or Village ............ ............ Jeff _8Z.san............. _................................ County ® Old Age Assistance ❑ Blind Assistance ..... -.... -..................... -...... ,T. u1Y.....210.,1939----- --------- -..... 19 Application Number In compliance with State Assistance Statutes in Section 68 Comp. St. Supp. 1937, 1 hereby declare the following described real estate as all of the real estate owned in whole or in part by myself and/or my spouse. 1. Legal description of real estate used by me as place of my residence: None 2. Legal description of all real estate not used by me as place of my residence: Lot 3,Bloczk 19,Clark4-s addition to City of Grand Island, Hall County, Nebraska. RECEIVED Jul 25 1939 Pursuant to the Enactment of L. B. 89, by the 55th Session of the Legislature of the State of Nebraska and approved May 12, enc e 1941, authorizing the Register of Deeds to release the Old Age Assistance liens of record, I.Jugeby release the v lien this 2!... day of ... .lif!Ll.!!......, 1941./ Register of Deeds -------------------......................... ..-- --- ---- . --- ----------- - . Signed ..... ............... ................ .......... ----------------------------- Witness Applicant for Assistance VERIFICATION not have investigated the ..... . ...................... _......... Hall ..................... -................. County records and hereby certify the above description(s) to be correct to the best of my knowledge. To: State Assistance Director, 1008 State Capitol, Lincoln, Nebraska ............ ... -- .....---------------------T...9...Ha.W-es---.._.........------------------------......----------------------- County Assistance Director or Visitor ................ ..... ........ Hal -I ...-------------------.County -------------------- _- NOVA ------------------19 39 Received for record Certificate of Award for Application No -------- .......333.--101.---------------- (Old Age Assistance), (Blind Assist- ance) at .... _._..2 ------ _-------------- o'clock and..... 3.0 ... _........ minutes ....P. ... M. in compliance with Sec. 68-258 Comp. St. Supp., 1937 as amended by L. B. 389, 53rd Session Nebraska Legislature, or 68413 Com. St. Supp., 1939^^c Book 1 Page 4 Signed.._ ............(...._....�............................ Register of Deeds