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This is a True Copy of Certificate Originaly Issued NEBRASKA '--------- -------------------------------------------- BOARD OF CONTROL Director of Assistance DEPARTMENT OF ASSISTANCE AND CHILD WELFARE N° 149 DECLARATION OF OWNERSHIP OF REAL ESTATE City or Village -- ................'Ul......----- .....................---------- ..... --------..... County Old Age Assistance ❑ Blind Assistance ------------------------------PAY- 1D-------------------- ...... ..................... 19....40 ---------- ---- �-1-72-1........................... --------------------- ....................... -..... 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: Lots 5 & 6,Hlook 12,01arkson's First Addition to Alda. Pursuant to the Enactment of L. $. 89, by the 55th Session of the Legislature of the State of Nebraska and approved May May 12, 1941, authorizing the Register of Deeds to release the Old Age Assistance liens of record, y rele se the w' in f n this 1941. Register of Deeds ...day of ......ile-lvll � t - ............ ............ I!'Il l '.a. el ..Alat anY.....-.... .......... Signed ............ - ...------Norg=-.-H...,TraV18 - ..-.. ...... _............................. Witness Applicant for Assistance VERIFICATION have investigated the.............................U11................... ................ ..............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, -----------------u"le1 Anthon. ............................ -.... -........... County Assistance Director or Visitor ------------------------ 1 ...... ......... ........... County, Lincoln, Nebraska --------------;i .......19..... Received for record Certificate of Award for Application No ......... 172-R3. .............. (Old Age Assistance), (Blind Assist- ) ..........o'clock and..... 30..............minutes ............M. in compliance with Sec. 68-258 Comp. St. Supp., 1937 as amended ante at.......... -$1...------_. by L. B. 389, 53rd Session Nebraska Legislature, or 68-413 Com. St. Supp., 1939. J nuary 1940 Book 1Page 149 Signed ------- ----------- ----- ---- ---- -.c cv"'- MY---------------------- Register of Deeds