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DUPLIOATE <br />OLD AGE ASSISTANCE CERTIFICATE No.......... --57 ............... <br />..............................1W.1 ...................... County, Nebraska <br />Name...... QUQUAD .. XQAX ........................................................................................................... <br />Age ..... 73 .......... Address...... 232..8...Pina..St...jGran&..Island.,,Nabz. .......... <br />Amount $...15.,,00 .............. Modified Amount $................................$................................ <br />Date ............ A00A.A.? .................19 36.. <br />This is a true copy of Certificate originally ......... ............... <br />Director of Assistance <br />issued. <br />x.............. .................... <br />Director of Assistance Sign.tum of Applicant Next Friend or Guardian <br />