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This is a True Copy of Certificate Originaly Issued NEBRASKA l� �T 2 123 .........................irector of Assistance BOARD OF CONTROL DEPARTMENT OF ASSISTANCE AND CHILD WELFARE DECLARATION OF OWNERSHIP OF REAL ESTATE ® Old Age Assistance ❑ Blind Assistance ...... ...............mo d....Aime r--------------............._..... ---------• -----......------------------ January.. -27 - ............................. 19.._40_._. City or Village Hall--------------------------- �_-... 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: 51 of Lots 4,5,& 6;Alock - 2, Original mown of Wood River 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 56th Session of the Legislature of the State of Nebr=ek a12, SQndhep {ved 1* n his 1941, authorizing the Register of Deeds to release the Old Age Assistance liens of record, I Airt7) le —. .. qday of �.G!/L...., 1941. Register of Deeds ....... Xankin----------------------------------------------- Signed.............................John....Coomes. .... ---------...-. --------------------------------- Witness Applicant for Assistance VERIFICATION have investigated the ------------ ------------------- H , al " 1 ---------------- - ------------------_--_---- County records and hereby certify the above description(s) to be correct to the best of my knowledge. ------------ ----- - ------------ -... -------•-1M_ur...el..._Anthony----------..................... .... ...... County Assistance ftmWmiM Visitor To: State Assistance Director, Hal County 1008 State Capitol, Lincoln, Nebraska-----------------February_--.-9....... ......... 19---AQ___-- Received for record Certificate of Award for Application No. ---------- -__8_-484__.-_-___. (Old Age Assistance), (Blind Assist- ance) at ............... 9-..-_-------------- o'clock and ._.__...-- =.-..minutes ......-.r_.M. in compliance with Sec. 68-258 Comp. St. Supp., 1937 as mended by L. B. 389, 53rd Session Nebraska Legislature, or 68-413 Com. St. Supp., 1939, and L. B. P2 January 1940 Book 1, Page 123 Signed ._........----------------9- --Q_ .-------------- Register of Deeds