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This is a True Copy of Certificate Originaly Issued N2 NEBRASKA l� Director of Assistance BOARD OF CONTROL DEPARTMENT OF ASSISTANCE AND CHILD WELFARE DECLARATION OF OWNERSHIP OF REAL ESTATE ----- - ---- -............... Dr.and .Island ................................ City or Village ............... .......... -H.B.a.l.....-----------------------------..._.._------------- County 92 ;[j Old Age Assistance ❑ Blind Assistance ------------------------------------.D.ecembr----�........... ..... I9..3.9..__ _........-- ---- ...._.._--- ----------8. 5.57. --------------- - - .---------- ......................... 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. I. Legal description of real estate used by me as place of my residence: North 39 ft.of Lot 1,Block 4,Hann's 2nd 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, authorizing the Register of Deeds to release the Old Age Assistance liens of record, reby rrele�as'e�[he (Wilt lie n this �!.. day of ........ .-Gf!%'t-`..... , 1941.� "— U.�. Register of -Deeds --------------------------------HarrelWthony------...... ----------- ------ ---- Signed._._. ---------------------- B_._W-NQ—rlk--------- ---------- ---------------------------------------------- ------------- Witness Applicant for Assistance Husband of Carline Monk. VERIFICATION have investigated the ------------------------- Hall ............ .......................... .............. County records and hereby certify the above description(s) to be correct to the best of my knowledge. ----................... -............................. Muri_el..._Ant ho ny-------------------------- -------......... County Visitor To: State Assistance Director, ...................... 1......_.._.........._...........County 1008 State Capitol, Lincoln, Nebraska-----------`raIlUary....�-----------------------19----40... Received for record Certificate of Award for Application No..............$.`:756........................... (Old Age Assistance), (Blind Assist- ance) at ........... ..... 20 ............ 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. and L. B. 2 ,J nary 1940 Book1 , P 8g IC 92 Signed---------------------------- ------------- ----------- - --- -- ----------- ------�t`�-------------- -- Register of Deeds