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This is a True Copy of Certificate Originaly Issued ------------- N e UA &nd emo 0r --------------------- Director of Assistance DEPARTMENT NEBRASKA BOARD OF CONTROL OF ASSISTANCE AND CHILD WELFARE N2 12 DECLARATION OF OWNERSHIP OF REAL ESTATE Z] Old Age Assistance ❑ Blind Assistance : .............5 r...and I�1---------------- ....--.......-.....------......-�Q�a9--------.....-....-----.----.19--�9 ..... City or Village -------------------------11ta1.... -................ - ............................... ---.................... -..............---- -x-3.10----------- ------------------------------------ ........ ................ 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: LOU 4 & 5,Blook 64,Wheeler de Bennett) a 2nd Addition. (Reoorded in the name of Mary ,C.Beavers) 2. Legal description of all real estate not used by me as place of my residence: Pursuant to the Enactment of L. B. 89, by the 55th Session of the Legislature of the State of Nebraska and approved May 12, 1941, authorizing the Register of Deeds to release the Old Age Assistance liens of record, eby release the pUl lien this ................... �.... day of.......444 • , 1941. Register of Deeds _.... - - _.. I=1.01 Anthomy -------------------------- Signed------....... ------- �Ieoob Q-,Besvere ........... Witness Applicant for Assistance Husband of Mary G.Beavers VERIFICATION have investigated the .--_ .................... .............Hall--........ ..................... ....-...County records and hereby certify the above description(s) to be correct to the best of my knowledge. ------------------------ -- -puri- ....Anthony............... - ... _._..... County As1MaWwa Visitor To: State Assistance Director, ........................Ala ............. ............. _.......... County 1008 State Capitol, Lincoln, Nebraska-------------------November---2s--------19-39------ Received for record Certificate of Award for Application No ..................... $`---'310-------------- (Old Age Assistance), (Blind Assist- ance) at ------------ 9....._.............o'clock and_ ............ .._.......minutes .....A..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. Signed ...... ....... ....�.......'... .----------- Book l. -page 12 Register of Deeds