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001-043
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Last modified
7/8/2017 6:44:40 PM
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7/3/2017 5:44:49 PM
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OLD AGE ASSISTANCE CERTIFICATE <br />No...... -6i{i................. <br />........................ gal..........................County, Nebraska <br />Name....... X99...$AW.AAA..Jpn.ip Guthrie ............................................................................. <br />Age ...... 7.9........ Address .... B15 ... Iftat... j8U-#eke:CiXAA4... 101AZda.lel?x ............ <br />Amount $.....20..00............ Modified Amount $ ................................ $ ................................ <br />Date ........... UY ..I s W7 ............19........ <br />This is a true copy of Certificate originally <br />issued. <br />..............Nl .......... <br />Director of Assistance St <br />t <br />BiBned ...Ir1. D . Tcl on <br />.......................... <br />Director of Assistance <br />................................................................................. <br />Signature of Applicant, Next Friend or Gu an <br />
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