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Last modified
7/8/2017 6:44:18 PM
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7/3/2017 5:44:49 PM
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DUPLICATE <br />OLD AGE ASSISTANCE CERTIFICATE No....8.-681.................. <br />Hall ......................County, Nebraska <br />Name .......... r .�... Nara.. ".:.Mart-in:....:........:.::.:............:...................:.................:.......... <br />Age 66 ............. Address..190.5.... Capit.ol . ... Ave. . . ....Gr....and Island....,.Nebr. <br />.... <br />....................................................... <br />Amount- ................. Modified Amount $ ................................ $ ................................ <br />.October 1 <br />Date.................................................... <br />Frans. from Douglas Co. <br />This is a true copy of Certificate originally <br />issued. <br />Director of Assistanoe <br />............... Nail ... C..V.andi mo.ex.................... <br />Director of Assistancefl <br />.................................................................................. <br />Signature of Applicant, Hent Friend or Guardian <br />
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