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Last modified
7/8/2017 6:46:33 PM
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7/3/2017 5:44:53 PM
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r <br />DUPLICATE <br />OLD AGE ASSISTANCE CERTIFICATE <br />y <br />No. ....... 8-55 3 .............. <br />......................... ...........................County, Nebraska <br />Name............... ClIntcan...D.Bmf,th........................................................ .................................... <br />Age..... 74......... Address ......... Waad..Riv.er...... I.ebr.»..................................................... <br />Amount $.13...QA................. Modified Amount $ ................................ $ ................................ <br />Date....-AU&II5:1... 3 .........................19..',26. <br />This is a true copy of Certificate originally <br />issued. <br />....................Noll .... G.-Vandi494laer...... <br />, Director of Assistance SL <br />( Sigaed.j......Sr1....D.. Tod en .......................... <br />Director of Assistance <br />................................................................................... <br />Signature of Applicant, Next Friend or Guardian <br />
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