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This is a True Copy of Certificate Originaly Issued NEBRASKA NO Director. of As BOARD OF CONTROL DEPARTMENT OF ASSISTANCE AND CHILD WELFARE DECLARATION OF OWNERSHIP OF REAL ESTATE --Doniphan. --------- ----------------------------------- City or Village Hall --------------------------- --------------------------------_--------------------------------._... County' 76 7g] Old Age Assistance ❑ Blind Assistance December. -14, ........ ... ........... 19.----9 8-250 ........................... - --------------- ...................... -------- --------------_---.._...- 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: Lots 5 & 6, Block 1, Burger's Addition. 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; authorising the Register of Deeds to release the Old Age Assistance liens of record, hereby release the ,hGinC�lienntthis day of........,(/1/!!LG...., 1941. ..............L�/.(`J... Register of Deeds ----.._..........�[urlel----Anthony -------------- Signed------ ...........................Luella _Rhodes----- ........ .................................. Witness Applicant for Assistance Wife of L.G.Rhodes VERIFICATION have investigated the............................._......:._Hal l .--,.......... County records and hereby certify the above descriptions) ----------------- to be correct to the best of my knowledge. To: State Assistance Director, 1008 State Capitol, Lincoln, Nebraska Muriel Anthony ---------------------------------------------------------------------------------------------. ............................................. County A"LUMMrSireetv. r Visitor Hall .............. County December 21 -I9._._1.9._ -- Received for record Certificate of Award for Aplication No -------- 8.'1.0...___._._ _.__.-._.. (Old Age Assistance), (Blind Assist- ance) at ----- -..-_----1...--._ ....... .o'clock and ..... ..... -__-......_.minutes .!rA...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. -�c-�� Signed - - t Book 1, Page 76 Register of Deeds