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DUPLICATE <br />OLD AGE ASSISTANCE CERTIFICATE <br />................. <br />...................... I -1a.11 .............................. County, Nebraska <br />Name... ...................................................................................................................... <br />Age.....( ......... Address .......... WaQd..R1v.er'.,....Xe.br .. .................................................... <br />Amount................ Modified Amount $................................$................................ <br />Date ...... Augual....3, .................... 19 ..... 36 <br />(Bigned) ...... Irl ... D—T-olen ....................... <br />This is a true copy of Certificate originally Director of Assistance <br />issued. <br />......Kell.... . Q..YSluldemaer .................... ........................ ......................... <br />, Director of Awistanc- 3L Signature of Applicant, Next Friend or Guardian <br />