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This is a True Copy of <br />Certificate Originaly Issued <br />Director of Assistance <br />NEBRASKA <br />'BOARD OF CONTROL <br />DEPARTMENT OF ASSISTANCE AND CHILD WELFARE <br />N° 1'7 <br />DECLARATION OF OWNERSHIP OF REAL ESTATE <br />M Old Age Assistance <br />❑ Blind Assistance <br />-....... ........ .......... Gr$nd....Island .................... - vemb. _1Q--_-----------.-.....19.39-_.- <br />City or Village <br />--------- ..................................................-'--'----------'--------------................. - ................ --- -i Ti-------------------------------................ -•-.............. -........... <br />County Application Number <br />In compliance with State Assistance Statutes in Section 68 Comp. St. Supp. 1937, 1 hereby declare the following described <br />real estate as all of the real estate owned in whole or in part by myself and/or my spouse. <br />1. Legal description of real estate used by me as place of my residence: <br />East 40 feet of Lot 3 ,Block 16 ,Original town. <br />2. Legal description of all real estate not used by me as place of my residence: <br />Pursuant to the Enactment of L. B. 89, by the 55th Session of the Legislature of the State of Nebraska and approved May 12, <br />1941, authorizing the Register of Deeds to release the Old Age Assistance liens of record, I reby release the <br />lien this <br />(�%2ti....., 1941. <br />...day of ......� Register of Deed <br />__.... -M13I' f 9 Afl'Ch©AST. - Signed ........................ ®I1D$.._BT$ ld... . ------ ----------------.-------------- <br />Witness Applicant for Assistance <br />VERIFICATION <br />have investigated the ............. __............. ......... JIL1.................. County records and hereby certify the above description(s) <br />to be correct to the best of my knowledge. <br />To: State Assistance Director, <br />1008 State Capitol, <br />Lincoln, Nebraska <br />Murie_ 1..._Anthony ............................ County Visitor <br />........................ ...... _11.la ,.....----------.-.------County <br />------------- Nov-etnber----------18........... 19 <br />Received for record Certificate of Award for Application No ----------- .._._$ 747-------------------- (Old Age Assistance), (Blind Assist- <br />ance) at...._9........................ _..o'clock and........ ......... ....... ..minutes -A -s. -M. in compliance with Sec. 68-258 Comp. St. Supp., 1937 as amended <br />by L. B. 389, 53rd Session Nebraska Legislature, or 68-413 Com. St. Supp., 1939. <br />Book 1 sPeze 17 Signed ........... ................... /G�------------ - -- - <br />Register of Deeds <br />