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i <br />Form D A—Revised 7-44 33149—THEAUGUSTINE CO. GRAND ISLAND. NED R. <br />e r -w S a' 7Perl�wa <br />CERTIFICATE QE AWARD9 <br />No.. j <br />Type of Aid .............. 41d.._ e.. Ass. s an...... ............... <br />1 <br />Name ........ :.....S -0.1a m �. r' S: Ida.............................. Age ........67................. Number ......---....1-1452-A1................................... <br />..... ........................... _.County................,A.... <br />Address......................B4�....16�.,Mj2Pd...R YgK-21eb-ras1ra.......... dams.................................................. <br />OriginalGrant $... 4..I4............................................................................... .......................................:...Date............2-1-4........................................ ...._---..............19:.-....... <br />NAME OF CHILDREN v I BIRTH DATE <br />(Will be filled in only if .used as certlfieate for children securing aid for dependent <br />children.) <br />Property description:. <br />Lot 12,Block 1,Dodd & Marshall's <br />Addition to Wood River,Hall County, <br />Nebraska <br />RELATIONSHIP TO PAYEE <br />Signature of Payee Director of Assistance and Child Welfare <br />�'<3° <br />ej <br />