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DUPLICATE <br />OLD AGE ASSISTANCE CERTIFICATE <br />No. ....... 6.- 622 ............... <br />...................... Hall .............................. County, Nebraska <br />Name.............. Xrs....Rose... AIM , Jane...Nel.son................................................................ <br />Age....IZ .......... Address ........W.Qal ..River..,....Nabx........................................................ <br />Amount $..;LZ,.QQ............... Modified Amount $ ................................ $ ................................ <br />Date ..... Fgbx.Uaxx...5,................19......3 7 <br />This is a true copy of Certificate originally <br />issued. <br />ell...C.�.VandemQ r .............. <br />Director of Assistance SL <br />Signed.�....Irl........Tolen.......... <br />Director of Assistance <br />.................................................................................. <br />Signature of Applicant, Next Friend or Guardian <br />