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001-093
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Last modified
7/8/2017 6:46:11 PM
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7/3/2017 5:44:52 PM
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06 �4� <br />OLD AGE ASSISTANCE CERTIFICATE <br />No...A=6 Q .................. <br />......................... IW.I............................ County, Nebraska <br />Name .....1.1..111 ?.. i1.6...PePAod.Y........................................... <br />.......................................... <br />Age..7.�............. Address...... 44a.. v.4r.tl�ebr........................................................... <br />Amount $.I.S...QQ................ Modified Amount $ ................................ $................................ <br />Date .......... Ma4Y...3.p .........................19.37. <br />This is a true copy of Certificate originally <br />issued. <br />......... s�.1....Q.1.vanamaer................ <br />k Director of Assistance <br />8.L. <br />£dined).. Irl D. T©les. ............................... <br />Director of Assistance <br />................................................................................. <br />Signature of Applicant, Next Friend or Guardian <br />
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