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DUPLIOATZ <br />OLD AGE ASSISTANCE CERTIFICATE <br />..................... 1W.1. <br />/11 -111, <br />....................County, Nebraska <br />Name .............. Jame.6 .. L.AQUOk.- .................. ........ - <br />..................... ....... . .................. <br />Age ..... 66 ......... Address .......... 422 .. N..I[a].=.t ... St....s.Gxj31A ... iiaand ................. <br />Amount $....12...00 ............. Modified Amount $................................$................................ <br />Date.......... May ... i2.s ......................19..3 6. <br />This is a true copy of Cortifirgato originally <br />issued. <br />................. M0 , a , <br />Director of Assistance <br />....(.Signed )... Irl ... D ........ <br />Director of Assistance <br />.................................................................................. <br />fliquatum of Applicant, Next Friend or Guardian <br />