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This is a True Copy of Certificate Originaly Issued NEBRASKA NO ......................... ...................... Director of Assistance........................ BOARD OF CONTROL DEPARTMENT OF ASSISTANCE AND CHILD WELFARE DECLARATION OF OWNERSHIP OF REAL ESTATE Gravid----- lsla:rd -------------------- -----_----------_--------------_-...... City or Village H.a.11...---------- -.. _---------_-_--------------------------------------- _------- County 112 K] Old Age Assistance ❑ Blind Assistance ------------------------N©vembax 9 ---------------------------------------- .-------- 19._x-9-_--_ .............. ..._----------------- - e- f12------------------.....-------------------......----................... Application Number In compliance with State Assistance Statutes in Section 68 Comp. St. Supp. 1937, I 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: N2 of Lot 1, Block 17, Original Town 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, I eby release the lien this 1941. ds ... ?! .. day of ....... �� Register of Deeds -- ....... -..... ------Murl-e1 -An th MY ..._..... - -----_.._... Witness have investigated the .......................... to be correct to the best of my knowledge. To: State Assistance Director, 1008 State Capitol, Lincoln, Nebraska Hall Signed- ....................... Kate- - - -- - --- - -- Applicant for Assistance VERIFICATION records and hereby certify the above description(s) _.................................. -------------- 1dur.-1 eJ_..An.thonY..------....----------------------------------- County Ik&Uaca.DirxiaF-or Visitor --- ...................... H_&11 ----------------......-----County - E-ebr uar y - 2-------------------------19- - 40 Received for record Certificate of Award for Appli,ation No ------- ..---.6--712 ----- ------------------ (Old Age Assistance), (Blind Assist- ance) at- ............. JQ...............o'clock and ........................... minutes ...P._M. in compliance with Sec. 68-258 Comp. St. Supp., 1937 as amended by L. B. 389, 53rd Session Nebraska Legislature, or 66-413 Com. St. Supp., 1939. and JgxiX gamy x1940 Book 1, Page 112Signed...........- ..............._`Jl„- -Register ot(`D.e%/d✓f 5-----••--- -fl ----------:-------------