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This is a True Copy of <br />Certificate Originaly Issued <br />NEBRASKA jr �T <br />2 108 <br />------------------------Director-of Assist ance........................ <br />BOARD OF CONTROL <br />DEPARTMENT OF ASSISTANCE AND CHILD WELFARE <br />DECLARATION OF OWNERSHIP OF REAL ESTATE <br />L3 Old Age Assistance <br />❑ Blind Assistance <br />----------Gr-and I.z-1 a nd---------------------------------------............. ....................... January -.2.3--- ---------- _ ......................... 19....? _.... <br />City or Village <br />-------H 11 ------------------------------------------------------------------------------- ............. -..... `t:`t-.xt..................... <br />County Application Number <br />In compliance with State Assistance Statutes in Section 68 Comp. St. Supp. 1937, 1 hereby declare the following described <br />real estate as all of the real estate owned in whole or in part by myself and/or my spouse. <br />1. Legal description of real estate used by me as place of my residence: <br />Lot S, Block 11, College Addition to West Latin <br />2. Legal description of all real estate not used . by me as place of my residence: <br />Pursuant to the Enactment of L. B. 89, by the 55th Session of the Legislature of the State of Nebraska and approved May 12, , <br />1941, authorizing the Register of Deeds to release the Old Age Assistance liens of record, Ieby rel w lien this <br />�.... day of....... 1941. <br />Register of Deed <br />Mur-J-e-1---An-t.h-ony-------------------------------- ------------------------ ------ Signed ............ --- ............... Julia..-Wann.er....--------......----------------------------------...... <br />Witness Applicant for Assistance <br />VERIFICATION <br />b <br />have investigated the ............................. .......Hall .......................................... County records and hereby certify the above description(s) <br />to be correct to the best of my knowledge. <br />---------- Antho.n - .......................... ................... <br />County Assistance Diwcio&ar- Visitor <br />E3E 3E 3E 3E 3E3K3F3 <br />To: State Assistance Director, <br />1008 State Capitol, <br />Lincoln, Nebraska <br />Hall-.- ........................................................ County <br />- Kebr--u ar 3r 2-,------ ------------------19 40 --- <br />Received for record Certificate of Award for Application No ........ i .� -4 1 (Old Age Assistance), (Blind Assist- <br />ance) at .......... 1Q .... _.... _........ o'clock and...........................minutes----- ------ M. in compliance with Sec. 68-258 Comp. St. Supp., 1937 as amended <br />by L. B. 389, 53rd Session Nebraska Legislature, or 68-413 Com. St. Supp., 1939. am Deeededs sLa�ry 19+0 <br />Book 1, Register of Page 108 Signed ................. .: ------.-- --'`'` ---------------- <br />Reo <br />