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This is a True Copy of Certificate Originaly Issued NEBRASKA N° Director of Assistance . BOARD OF CONTROL DEPARTMENT OF ASSISTANCE AND CHILD WELFARE DECLARATION OF OWNERSHIP OF REAL ESTATE _GrandIs Island ...._ ........... City or Village Hall County 1 • ® Old Age Assistance ❑ Blind Assistance 19 ............................-- - 36�A---------------•-- ........----- -- -- - - 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 and 6,Block 27,Original Town of Wood River.This property is recorded in the name of my ileceaisdd husband,John N.Kelly. 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 h Blease the within this .. day of .... (/1/i�:Ci...., 1941. Vj Register of Deeds Jean McGrath ----------------- Signed------.............................ul-ia.--Kelly----- ... --- ._..... ...... ......... -.... 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 --------------------------.... -............... .Joe G. Lutgen.--.....----------- .fww tyalssistanee4Dkwetsr er-Visitor -..... -Hall - County ------------ ------ Nov ._..20---•----------..-- I9_©........ Received for record Certificate of Award for Application No.. -_..2 75.5.3 4 ............. (Old Age Assistance), (Blind Assist- ance) at.........._.$....................o'clock and ..... - ... .3.©. ....... minutes ....A -,M. in compliance with Sec. 68-268 Comp.Sec. St. Supp., 1939 as amended �n d 6 S - by L. B. 2,; _41WA Session (Exhv ordl;rary) Nebraakw d r�%s /a/0'-fo �/3 Book 1 Fake 1001%� I ' Signed------------- .�-. - - - -- -� --------------- . Register of Deeds m narsnw m. aww �.uro, .s..