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This is a True Copy of Certificate Originaly Issued ate.1lUandemo-er............................ Director of Assistance NEBRASKA BOARD OF CONTROL DEPARTMENT OF ASSISTANCE AND CHILD WELFARE N° 5 DECLARATION OF OWNERSHIP OF REAL ESTATE :K] Old Age Assistance ❑ Blind Assistance ..... _....... F i..rburx-Neb...r---................................ - ....... --------------............. City or Village -------------_J-Off_er-aon.--------------------------.............:......------..---------------3.3--7. County 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 ,Block 19 Clark's Addition to City of Grand Island, Hall County,Nebraska. RECEIVED .Tiil 79 10-40 Pursuant to the Enactment of L. B. 89, by the 55th Session of the Legislature of the State of Nebraska and approved May 12, encs 1941, authorizing the Register of Deeds to release the Old Age Assistance liens of record, I herebreelease the w'thin�lien J this y.... day of - - - - ....., 1941. /!.r2 .� /✓ + Register of Deeds O ..... :..... Signed........ - ......t............. urner............... ............. _....... - Witness Applicant for Assistance VERIFICATION notInformation from Hall County Assistance office have Investigated the ...-..------ -------- H&11.............................:...........................County records and hereby certify the above description(s) to be correct to the best of my knowledge. HaWe. e. .............----------------------..... County Assistance Director or Visitor To: State Assistance Director, ----------------------------------.-_Hall .................... County 1008 State Capitol, Lincoln, Nebraska ..........----------..NO.Y....8------- ----------- 1939 Received for record Certificate of Award for Application No .............. 3.3.��7.......................... (Old Age Assistance), (Blind Assist- ance) at ............. 2 ------_----...._..o'clock and...._....3Q......-.minutes ....P...M. in compliance with Sec. 68-258 Comp. St. Supp., 1937 as amended by L. B. 389, 53rd Session Nebraska Legislature, or 68-413 Com. St. Supp., 1939. Book1 Pale 5 Signed -----------------------------------J--- - - - - _._.. ------------------ Register of Deeds