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Last modified
7/8/2017 6:44:31 PM
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7/3/2017 5:44:49 PM
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149'G6� <br />OLD AGE ASSISTANCE CERTIFICATE <br />No........ 0-5.7.7 .............. <br />................................. . �W.!..................County, Nebraska <br />Name...... .AX.tllU;C...A. XIR.................................................................................................... <br />Age.. 5............ Address ..................... Aldaa.16tZ...................................................... <br />Amount $....15...00 ............. Modified Amount $ ................................ $ ................................ <br />Date .......... V�".�.Ej.......................19........ <br />This is a true copy of Certificate originally <br />issued. <br />.............. C.vando.�tr............. <br />Director of Assistance SL <br />{.81ned) Irl D.Tolen <br />....................... <br />Director of Assistance <br />.................................................................................. <br />Signature of Applicant, Nest Friend or Guardian <br />
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