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CERTIFICATE OF AWARD Old e <br />.. ................................................. <br />Type of Aid <br />Name.........(L.BmAd...................................................................... No ................................. <br />Address.......' 5..Kee�„6th St. Grand 1dl dun yboi...H811 <br />..... ........... <br />Changesof Address..................................................................................................................... <br />.................................................................................................................................................................. <br />Original Grant $ f5' T�........................... Date. October...1................. 19.3A. <br />Amount of <br />Grant <br />Date <br />STATUS <br />(Mod., Sump., Canc., Roo.) <br />Amount of <br />Grant <br />Date <br />STATUS <br />(Clod., Susp., Cana., Roo.) <br />Neil l.Y <br />................................................ ........... demoer. <br />.......................... <br />Signature of Payee Director of Assistance and Cw Welfare <br />