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....Old Age ASBASUAea <br />CERTIFICATE OF AWARD ............................ ......... <br />Type of Aid <br />Name .......... GOOT99..Balaom ................... �=�d...e ..d.. No.... !............... <br />Address ..... 13....NOX.th ... WAYA..U.R.i................. County of ........... Hall ................. <br />Changesof Address.......................................................................................................................... <br />.................................................................................................................................................................. <br />Original Grant �.2,t 6 .............. Date...... .0..It..................M.N. <br />$............ �.. <br />Amount of <br />Grant <br />Data <br />STATUS Amount of <br />(Mod., Snap., Cane., Rao.) Grant <br />Data <br />STATUS <br />(Mod., Busy., Cana., Rao.) <br />cyfi <br />dew or <br />................................................................................................ . <br />:. Signature of Payee Director of Assistance and Child Wa era <br />