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11011"� <br />OLD AGE ASSISTANCE CERTIFICATE <br />No...... 4-9.7 ................... <br />..................Na ..................................County, Nebraska <br />Name..... WUXI= ... R1d-QhQX-v-W . . ........................................................................................... <br />Age .... 7.0 .......... Address..... 13.0.8...2-fith.v-4rA'rd ... 19aiLlAalwahr . . ...................... <br />Amount $...17..00 .............. Modified Amount $ ................................ $................................ <br />Date ............... W.ZU...x...............19.. 6- <br />This is a true copy of Certificate originally <br />issued. <br />........... ]A <br />x.Q.ar ............... <br />Director of Assistance, <br />SL <br />........ Signed) ... P.,A91.94 ................ <br />Director of Assistance <br />.................................................................................. <br />Signature of Applicant, Next Friend or Guardian <br />