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This is a True Copy of Certificate Originaly Issued NEBRASKA N2 126 Grand.-Sala.nd........................................... BOARD OF CONTROL Director of Assistance DEPARTMENT OF ASSISTANCE AND CHILD WELFARE DECLARATION OF OWNERSHIP OF REAL ESTATE ® Old Age Assistance ❑ Blind Assistance -------------------( 1.rand 16.11 .....................-...-...--- -- -- Ye-bruary 2-,--.. ------------ ----- -.................... ....... 19....41a City or Village --------------------------------.................... .. ................. _...... 6 b ............ 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 3, Block 44, Russell Wheeler Addition. (Life estate) 2. Legal description of all real estate not used by me as place of my residence: SF -4 of Section 1, Township 12, Range 12. (1/3 interest) E2 of NW4 of Section 12, Township 12, Range 12. (113 interest) 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 theRegister of Deeds to release the Old Age Assistance liens of record, reby release the (witlpn lien this ... day of.... , 1941....... Register of Deeds ........... -........ --Xuriel....Anthony ----------------------- ------------ ----------------------- Signed .......................... -._Ev&..--.`I'a..gg-C'--------------------------------------- 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 -------------------- ._Miami.el....Axnth.4. ay.. ..... .._.................................................... -.----...... County Assistance DkeeS000r. Visitor ---------------------E . l--- ........... .............. ---........... County .................. February .-.-.26... ....... ..19 -40 Received for record Certificate of Award for Application No ........ S-6.14..------------------------ (Old Age Assistance), (Blind Assist- ance) at.-...__.9........................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. January 1940. Book 1 Page 126 Signed.------ ------ ------------------------ -... .. ---_----------------------- - Register of Deeds