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OLD AGE ASSISTANCE CERTIFICATE No....Arlgl.................. <br />............................ Hal ........................ County, Nebraska <br />Name ..... ThoR410...T Aq#.4...................................... <br />.................................................................... <br />Age ..... 61......... Address ...... #3.o.St UX.6ld0.. <br />Amount $.... IT-t.0Q.............. Modified Amount $ ................................ $ ................................ <br />Date.............April.. . x.................19.36. <br />This is a true copy of Certificate originaAy <br />issued. <br />Neil 0.4andemoer <br />............................................. ...................................... <br />, Director of Assistance SL <br />$i�ned� Iri D,Tolert <br />.............................. <br />Director of Assistance <br />.................................................................................. <br />Signature of Applicant, Next Friend or Guardian <br />