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upiiott <br />OLD AGE ASSISTANCE CERTIFICATENo......'„4—.. ................... <br />....................J.1axer9m................. County, Nebraska <br />Name....Ra].lie..SLmuar............................................................................................................ <br />Age ... 69........... Address .......... 1M3......6th..St.#FirbU r bZ ............. .:...... <br />Amount $..1Q..40............... Modified Amount$ ................................ $ ................................ <br />Date.......... XW-Ch... el.....................19....j6 <br />................ <br />This is a true copy of Certificate originally ,�..... Ill....i 8a <br />DiHot" of Afidstauce <br />issued. <br />..............psi. V.IIk,:IAelW= ................... ............................................................................... <br />Director of Anaiatance SL Signahwo of Applicant, Ne:t Friend or Guardian <br />