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DUPLICATE <br />OLD AGE ASSISTANCE CERTIFICATE No . ........ $=R5.0 ......... <br />HalCounty, Nebraska <br />Name ....Luella ............... .... <br />.............................. W ................................................... <br />........ ... .. .. ..... ..... <br />Age.......... M...,. Address......................................................... <br />Amount $..x:$.00............... Modified Amount $.................................$ ................................ <br />April 1 . . . ......... 19... <br />Date ................................ <br />This is a true copy of Certificate originally <br />issued. <br />Neil Vandemoer <br />............................................................................... <br />,-Director of Assistance <br />(Signed) Irl D. Tolen <br />.................................................................................. <br />Director of Assistance <br />.................................................................................. <br />Signature of Applicant, Next Friend or Guardian <br />