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DUPLI OATZ <br />OLD AGE ASSISTANCE CERTIFICATE <br />No...... 6 13.8 ................ <br />............................... lbal.................... County, Nebraska <br />Name.. A..Z.Amer....................................................................................................................... <br />Age....7.4 .......... Address .....721...Z.7.fiih.*... Grand ...laland.aIffeb.T....................... <br />Amount $..... 1kim............ Modified Amount $ ................................ $ ................................ <br />Date ........... ADT ,..1 A-936......19........ <br />This is a true copy of Certificate originally <br />issued. <br />Neil G Vandemoer. <br />Director of Assistance <br />S. L. <br />............. (As0............. <br />Director of Assistance <br />.................................................................................. <br />Signature of Applicant, Next Friend or Guardian <br />