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This is a True Copy of Certificate Originaly Issued NEBRASKA N- 80 Director.of Assistance BOARD OF CONTROL DEPARTMENT OF ASSISTANCE AND CHILD WELFARE DECLARATION OF OWNERSHIP OF REAL ESTATE FL] Old Age Assistance ❑ Blind Assistance - ...... ____ -------------Gran.d....- .01-an.....----------.--.....----Jo.nuar-y.--------1.------------- ---------- -..... 19.....4Q.._ ------------------------------------ -- City or Village -------._ ................ .............-_.Haa.1.............................................. ----------------------- ----------.-.-6..3.6 .................................... _.................. --------------------..... 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: South 49.33 ft.of Lot 4,Blook 76,Original Town of Grand Island. 2. Legal description of all real estate not used by me as place of my residence: Pursuant 4o 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 �eee�iy relea a the witkytr�jenn tPhiissia�� 2 ... day of. �/„!/!!K �.... , 1941. ................. v.�....... / (/ Register of Deeds ---------------------- L...Neut 8yll .-- ..----........................ ---------------------- Signed ................. i s...._Sor errs ell.---------- -.................. ................. Witness Applicant for Assistance VERIFICATION 1 have investigated the .............................. Hall 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 ----------------------------------------- - -------- u i_sl 9►n. h PAY ----------------------------- County Assistance D+*GtafsrVisitor -------------------------x81 l .................. - .......... County ----------------------- January. --- 29 ----------- 19-4Q Received for record Certificate of Award for Application No -------------- $--.6.3-6 ------------ _._.._ (Old Age Assistance), (Blind Assist- ance) at.._.___._._ _ o'clock and..-.. -._...minutes ....A .M'. in compliance with Sec. 68-258 Com St. Su 1937 as amended 10---------------- P gyp. PP•. by L. B. 389, 53rd Session Nebraska Legislature, or 68-413 Com. St. Supp., 1939Ad �r T fl V✓ teary 1940 Book 1,Page S`0 Signed - _. '`'`-' - ...................._.....------------------ .. ------------------ Register of Deeds