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This is a True Copy of Certificate originaly Issued NEBRASKA N2 -------------------------D.i -----rector --- A of A.----ssist- -anncece......................... BOARD OF CONTROL Di DEPARTMENT OF ASSISTANCE AND CHILD WELFARE DECLARATION OF OWNERSHIP OF REAL ESTATE g] Old Age Assistance ❑ Blind Assistance ----------------- -------------- Caira ....... - ......... ..........-------------- -............... ..... ............................. --------D ec emb er.--2....................... 19..3.9.._ City or Village - ..... -- -H i......................... - ............................................................... 8-tm - .......................... .................. 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: Ej of * of SEJ28ection 27,Township 122Range 12. 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 66th 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, I hep� releasee the wit n this 7, .. day of ....... . Zi!/YL�4...., 1941. .................. Register of Deeds MurielAnt Anthony................. -------------------------------------------------- Signed.------------ ............. 11 -W.n-- R.._GoS$.................... ................................... Witness Applicant for Assistance husband of Mary V.Goss VERIFICATION have investigated the ........------------------------- x&......_....................._..._.. .......... -County records and hereby certify the above description(s) to be correct to the best of my knowledge. --------------------------------------------------Afiiriel Anthony - - County Assistance Die ster-er Visitor To: State Assistance Director, ....................... ..................... Fie. l.___._____......____._County 1008 State Capitol, Lincoln, Nebraska--------J19MWIXy----i?9--------------------1940------- Received for record Certificate of Award for Application No ------- _8_-2Q4 ------------- --- -._.. (Old Age Assistance), (Blind Assist- ance) at................1Q.............o'clock and...... .__.._...minutes ...A...M. in 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. nd L . B . 2 , J .IaX y 1940 Book 1,Page 88 Signed................................... s-- - Register of Deed -