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DUPL IQATZ <br />OLD AGE ASSISTANCE CERTIFICATE .................... <br />....................... Hill ............................. County, Nebraska <br />Name .... MAZY ... 0AXQUna--X0XU9n9y....................................................:.......................... <br />Age .....6.5 ...... .. Address .......... 2431...$Q ui..P.arkj,...araud..Zalsnd.Pibz. <br />Amount $..12-.00 ............... Modified Amount $ ................................ $ ................................ <br />Date ........... NPI 5., ......................19..3 7 <br />This is a true copy of Certificate originally <br />issued. <br />Director of Assistance <br />........... Neill ...Q.Mmdsmagar.......................... <br />Director of Assistance <br />SL <br />.................................................................................. <br />Signature of Applicant, Nett Friend or Guardian <br />r <br />DUPL IQATZ <br />OLD AGE ASSISTANCE CERTIFICATE .................... <br />....................... Hill ............................. County, Nebraska <br />Name .... MAZY ... 0AXQUna--X0XU9n9y....................................................:.......................... <br />Age .....6.5 ...... .. Address .......... 2431...$Q ui..P.arkj,...araud..Zalsnd.Pibz. <br />Amount $..12-.00 ............... Modified Amount $ ................................ $ ................................ <br />Date ........... NPI 5., ......................19..3 7 <br />This is a true copy of Certificate originally <br />issued. <br />Director of Assistance <br />........... Neill ...Q.Mmdsmagar.......................... <br />Director of Assistance <br />SL <br />.................................................................................. <br />Signature of Applicant, Nett Friend or Guardian <br />