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OLD AGE ASSISTANCE CERTIFICATE No...17294 <br />...................... <br />........................ .Hal.1 1............................County, Nebraska <br />.......... <br />Name..... 111111P ... RAQ-0 ......................................................................................................... <br />Age ...7.5 ............ Address ....... BY.D..#3 ...... j0aixn.jAebr . . ................................................. <br />Amount $....12. QQ............. Modified Amount $................................$................................ <br />Date.......... 4aY ...5.P ........................ 19-36- <br />I <br />This is a true copy of Certificate originally <br />issued. <br />..............R ll ..... 0-119mamaer ............ <br />Director of Assistance <br />S.L. <br />P.1Tot AA ................ <br />Director of JUsUtanco <br />.................................................................................. <br />Signature of Applicant, Ke3tt Maud or Guardian <br />