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This is a True Copy of Certificate Originaly Issued 3 N0 11 NEBRASKA 3 ......................... Director of Assistance ........................ ------ BOARD OF CONTROL DEPARTMENT OF ASSISTANCE AND CHILD WELFARE DECLARATION OF OWNERSHIP OF REAL ESTATE ] Old Age Assistance Blind Assistance .......... -..... J�.and- -Island ........................ _.............. --------Januar-y-- -2-5 _.......... City or Village ------------------------------------------.............. ----------------.._---..-------------G3---5-2------------------------------------- ----------.....-.......-... .. 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: Lot 6, Block 28, Packer & Barrls 2nd Addition Recorded in the name of Martha Thayer, spouse 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 hereby release thh thin lien this 2 ... day of ....... . (/1/!!LL..... , 1941. Register of Deeds - M1.r-1.e1 An.thony.. Signed V.rnon----H_..Thay-er------------........... -----...................... Witness Applicant for Assistance VERIFICATION have investigated the -------------- --------------- _...-Hall.-.-..._---..-.-..--.- ....--.--..---_County records and hereby certify the above descriptions) to be correct to the best of my knowledge. To: State Assistance Director, 1008 State Capitol, Lincoln, Nebraska ............. -................... 3T------ --- -- .-...-----...-•--------------......... County Assistance giiYmUltor Visitor Hall-............................ ............ County - '_e br uar y- -2 , --------- -------19 - Received for record Certificate of Award for Application No. --g_ F— 2..-_-_.-___.____.-_ (Old Age Assistance), (Blind Assist- ance) at ..... ..... ...... 1Q ........... o'clock and---------------------------minutes-------.--M. in compliance with Sec. 68-258 Comp. St. Supp., 1937s amended by L. B. 389, 53rd Session Nebraska Legislature, or 68-413 Com. St. Supp., 1939 and L. B. 2 January 1;' 0 Book 1, Page 113 Signed.- ....................._z.0 ��i'- -- Registe.r of Deeds