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�y <br />Jftl <br />CERTIFICATE OF AWARD .................. QlA... up... As s i s twee..............,.,, <br />Type of Aid <br />Name ......... John ....MA ore................................................................ No............4.#©2 <br />.................................. <br />Address......Wood„Rivera...Nebr.:........................... County of .......... Hall.................. <br />Changesof Address.......................................................................................................................... <br />.................................................................................................................................................................. <br />Original Grant $.............. 18- 76 ............... Date.... January..1.............. <br />19... . <br />Amount of <br />Grant <br />Date <br />STATUS Amount of <br />(Mod., Soap., Canc., Rao.) Grant <br />Date <br />STATUS <br />(Mod., Snap., Can*., Roo.) <br />.................................................................�................... N.0 1.......Vande�oer ....:ft <br />Signature of Payee Direator of Aasietanoe and Child Welfare <br />