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This is a True Copy of Certificate Originaly Issued NEBRASKA lr �T O ......................... ... Director of Assistance BOARD OF CONTROL DEPARTMENT OF ASSISTANCE AND CHILD WELFARE DECLARATION, OF OWNERSHIP OF REAL ESTATE ..... - ...... Grand .. Island- ----------------------_-----__.......... City or Village .......... Ha 11---............... ----------------------------------- ------ --- ----• County 109 n Old Age Assistance ❑ Blind Assistance -------------------------------- January 2-3 -------------------------------- -_ ..... 19._40.._ -------- -------8----- --_------- -- _--- _---- ---------------_--..-_----_-- 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: 2. Legal description of all real estate not used by me as place of my residence: Lot 4, Block 14, Lambert Addition 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 recor hereby release (tie/—+yithin lien this - ..., 1941. �lt day of....... ,�� Register of Deeds ------------- Mur_ el.An.thony--------------------------------_-- .. Signed Anit-a Palomares ............. -- --- --- .------ .------. -----------•--------------------..........---------------------- Witness Applicant for Assistance VERIFICATION have investigated the .. .......... ............Ha.11............ ___..__.._.......County records and hereby certify the above description(s) to be correct to the best of my knowledge. ...................................... uriel.- Anthon.Y._.....------------------••----'----- . - County Assistance Disss4w_" Visitor To: State Assistance Director, ................. all........... ................ ..........County 1008 State Capitol, Lincoln, Nebraska ---- ----- Febr-uar-ji_._____2------ ----------- 19._4Q____.- Received for record Certificate of Award for Application No.. -_$`-•81-7 .....------------ _._--- .-.... (Old Age Assistance), (Blind Assist- ance) at..........._10........ _........ 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 68-41.3 Com. St. Supp., 1939. ('��Ja)ary 1540 Book 1 Page 109. Signed ........... ............ ........�.�( Re........................................ eds ....---........._.... ------.-..-..._..-- � g Register of Deeds