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1UPLIOATS <br />OLD AGE ASSISTANCE CERTIFICATE No, .................................... <br />Iia11.................County, Nebraska <br />Name....... ufus L.Davis......................................................................................... ........... <br />Age....66.......:.. Address......%16 East gth�....Grand Island.Nebr. <br />Amount $......1 � . DO...... Modified Amount $ ................................ $ ................................ <br />Date..... Aptil...l.v.......................19. 6. <br />This is a true copy of Certificate originally <br />issued. <br />Neil C.Vandemoer <br />.................................................................................... <br />Director of As.ist nc. <br />1-z <br />(Signed) Irl D.Tolen <br />..................................................:............................... <br />Directory Aaabtance <br />.................................................................................. <br />, Signature of Applicant, Next Friend or Guardian <br />