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DUPLICATE <br />OLD AGE ASSISTANCE CERTIFICATE No. ...... 8.-,,224 ................ <br />.................. R?.Ll ,...................................County, Nebraska <br />Name.................. fax'y.... 5-FX-az.e11.............................................................. ' ........................ <br />Age ......... 87...... Address..42.4.2-Ski,..Gr-and... ls and.,.Neer............................... <br />Amount $.....11..00............ Modified Amount $ ................................ $ ................................ <br />Date -May ... 4 ................................... 19.. 3.6 <br />This is a true copy of Certificate originally CS1gn.e}...Ir ...Talen.............................. <br />Director of Assistance <br />issued. <br />.............................................. :............................................................. <br />Director of Assistance Signature of Applicant, Next Friend or Guardian <br />SL <br />