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This is a True Copy of <br />Certificate Originaly Issued �T <br />NEBRASKA 1r O 40 <br />Director of Assistance BOARD OF CONTROL <br />DEPARTMENT OF ASSISTANCE AND CHILD WELFARE <br />DECLARATION OF OWNERSHIP OF REAL ESTATE <br />® Old Age Assistance <br />❑ Blind Assistance <br />...... ----------------..._Grand---.Is_l�tnd.-•----------- ------------ <br />- ....... - -November ?....- I9.._39-_ <br />City or Village <br />..................................._......._411...................................... -................. .................... - 7 ._......- - .............. -- ...................... - <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 />Lot 5,Block 11,Lambert Addition. <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 y release the wi ien this <br />�... day of........ ...., 1941. ................. <br />Register of Deeds !J <br />_... - -- -Muriel- -Anthony - -- ....... - Signed-- --- -William 8.Ratche_r_ <br />Witness Applicant for Assistance <br />VERIFICATION <br />have investigated the.............------------------- <br />_HAl1---------------------------------------- .-.-..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 />-------------------------------------- -Mur lel. -Anthq ................ -.... ------•------ <br />County Visitor <br />-.......................... ............... Hal. .-.. County <br />-------------- ---- -Dec-.-- -6 ----- -- ---- --- ---- 19. - 39 <br />Receivedfor record Certificate of Award for Application No. ---_.__.__>-9_7______ ----- _------- . (Old Age Assistance), (Blind Assist- <br />ance) at ...... -... - .... - .................o'clock and ..... - .................... minutes ....P..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 l Page 4 Signed -.............................. �.--------- <br />Register of Deeds <br />