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OLD AGE ASSISTANCE CERTIFICATE No . ..... $::.555 ................. <br />............................ R%11 ........................ County, Nebraska <br />Name......... qPRqP ... Q4119,h8A .................................................................................................... <br />Age ..... 6-7 ......... Address ......... RoUte ... #1,s.Wood..Ri.v*x.j.X*br . . ............................. <br />Amount $.... 13..QQ ............. Modified Amount $ ................................ $................................ <br />Date .......... AUgUAt.3-P .................19.36. <br />This is a true copy of Certificate originally <br />issued. <br />-Nail .... 0-..'Vand*w*r .......... <br />Director of Assistance <br />S. L. <br />j.Sig ns I-r2—a.10.16A ................. <br />Director of Assistance <br />.................................................................................. <br />Signature of Applicant, Nezt Friend or Guardian <br />