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OLD AGE ASSISTANCE CERTIFICATE <br />No. -1:756 ...................... <br />.......................... 91a.1 ....................... County, Nebraska <br />Name.... BAIROAX .......................................................................................................................... <br />Age ... 75 ........... Address ........ 02 ... fj."PAAq .... ........ <br />Amount $....16. t.QA ............ Modified Amount $ ................................ $................................ <br />Date ..............,P;11...1.1................193 6 <br />This is a true copy of Certificate originally ................... <br />Director of Assistance <br />issued. <br />........... RAU .... ().A.Y. "dwo.1a ................ .................................................................................. <br />Director of Assistance Signature of Applicant, Next Friend or Guardian <br />