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This is a True Copy of Certificate Originaly Issued N° NEBRASKA ......................... ------ Director ------- of Ass -- Assist ------ anccee........................ BOARD OF CONTROL DEPARTMENT OF ASSISTANCE AND CHILD WELFARE DECLARATION OF OWNERSHIP OF REAL ESTATE Grand I s__l__ and City or Village Hall- - ................. ---------------------...---....--------------------------- County • 101 [X Old Age Assistance ❑ Blind Assistance ----- --------------------- Ja-nu-ary- 2-7 ................... ........... ....... .. .... 191 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: Lot 3, Block 30, Russell Wheeler Addition 2. Legal description of all real estate not used by me as place of my residence: Pursuant to the Enactment of L. B. 99, 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 recor herebyrelease the theain lien this .. day of C.Nrt.t-....., 1941. $ Re ister of Deeds ........................... .... Mur et Anthony. ................... .......... :................SignedTildaP.e-_t.er&o.n....................... __.............. ..... ........... witness Applicant for Assistance VERIFICATION have investigated the ................................... Hall ......................... ....... ........._County records and hereby certify the above description(s) to be correct to the best of my knowledge. To: State Assistance Director, 1008 State Capitol, Lincoln, Nebraska ................. -....................... Muriel -._Anthony.. - - - County Assistance Director -or Visitor --------------1 a-11-------------------------------------------.....County -Februcliry. 2: 19-40 Received for record Certificate of Award for Application No._.$. -1 Q.-6-- --------------------- -------- . (Old Age Assistance), (Blind Assist- ance) at ..... _...lp.....................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. 13.2 January 1940 Signed...................................�........................-��C �.. - 2fa,ok,..a..,42age 101 Register of Deeds